CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Raich
Pathologists and administrative staff likely won’t fully come to grips with the IHC billing problem until late February or early March, says Mick Raich, founder of the revenue cycle management company Vachette Pathology in Blissfield, Mich. In January, laboratories were still sending claims for services provided in December and were billed using the AMA’s CPT codes for IHC. Unfortunately, determining how to correctly bill IHC for patients with commercial plans may be clear only after practices start receiving denials for using the wrong codes and then file appeals, Raich says.
“It might take until June to get January’s money collected,” he says. “Only then will we know how bad the cuts are.”
Currently, practices can gauge the impact of the IHC and other fee schedule cuts. The bottom line number depends on the type of practice or laboratory and the case mix, says Raich, who has provided analyses for his clients. For instance, one analysis for a three-pathologist anatomic pathology laboratory in the Midwest showed a $159,000 total revenue decrease, or –28.6 percent, from Medicare when compared with 2013 Medicare payments. On the professional side, the total loss amounted to $4,600 per physician, or –5.1 percent.
The estimate for the laboratory was bleak, but the best-case scenario would not provide a rosier outlook, Raich says.
“It would still be pretty bad,” he says. “You are looking at a drastic change in the revenue system. There is only so much a laboratory can do to make money—you can’t just increase volume.”
Many laboratories will look to renegotiate contracts with vendors, Raich adds. Pathologists also will need to find new ways to be efficient, such as using automation features in health information technology systems.
“The pressure is on all physicians to provide more services under heavy regulatory burdens with less payment,” Dr. Strate says. “That’s unfortunate for patients and physicians.” n
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Charles Fiegl is CAP manager of advocacy communications, Washington, DC.