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Vachette & Stark Medical Auditing
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Vachette & Stark Medical Auditing's posts

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Our summary of the eGlobalTech and Palmetto GBA webinar on Comparative Billing Report webinar on CBR201407 Immunohistochemistry and Special Stains.

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It appears Blue Cross and Blue Shield of Minnesota (BCBSMN) has made a significant error in Medicare reimbursements and has just recently realized it.

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Our clients are asking about a new phenomenon — insurance companies who send an explanation of benefits (EOB) with “virtual” payment.  The EOB will state, “payment for this remittance is being made via virtual credit card; please process this payment as you would any credit card.”

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Updates from the Health Care Financial Managers meeting in steamy Las Vegas: The big news is that many RCM firms are “re-patriotating” their work, this means they are bringing work back on-shore from off shore firms. The other big thing is that many hospitals are simply struggling billing and collecting for their hospital owned practices. Most CEOs and CFOs we spoke with, we talked to over 50, noted that they thought that bundled payments would have been implemented sooner and they worry about staying profitable while waiting for this transition to take place.

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Are You Losing Revenue from Improperly Handled Denials?

I attended the Ohio Hospital Association meeting this week. Here is what I learned: Everyone is scared to death about the Health Exchange plans. No one is ready for bundled payments. Those hospitals that purchased physician groups are worried about the cost and revenue for these practices.

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Since January 2014, there are more and more issues coming out of the woodwork with FSH billing and reimbursement. 

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#Pathology #FSHBilling #FSH   #FSHReimbursement  

We found a hospital based practice in the Twin Cities area where the biller was charging less than BCBS was willing to pay! The biller fixed the error for our client and then told all their other clients that they had found this issue and took the credit for our victory. Classic!

Beware the “replicated EOB” This is an EOB that a biller may use to show the allowed amount. We have found billers and insurance plans providing us “replicated EOBs” that showed an allowed amount different from the actual insurance allowed amount. Obviously this leads to…well you know…LOST REVENUE!

A payer recently dropped their payments 30%! There was no reason given. We sent a termination letter…there was no reason given. Why accept a 30% pay cut from a publicly traded company that makes a 5% margin each year? Where is our 5% growth? Come-on! Negotiate a better living!
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