Ashley Phillips

Exclusive Update on Medicare Coverage Determination for Special Stains and IHC Stains by Palmetto and WPS Effective July 14, 2024, two Medicare Administrative Contractors (MACs), Palmetto and WPS, have finalized their Local Coverage Determinations (LCDs) concerning medical necessity guidelines for special stains and immunohistochemical (IHC) stains. These determinations, LCD L36805 (WPS) and LCD L35922 (Palmetto), provide clear and stringent criteria under which Medicare will cover these stains. Key Points of the LCDs: *Conditions for Coverage: 1.Medical Necessity: The special stains and IHC stains must be medically necessary to ensure a complete and accurate diagnosis is reported to the treating physician. 2.Communication and Utilization: The results of the stains must be communicated to and used by the treating physician in the patient's treatment plan. 3.Documentation: The pathologist must document in the pathology report the rationale for performing the additional stains. *Prohibitions and Requirements: -A statement in the pathology report that merely says "IHC confirms the diagnosis" will not be considered sufficient for coverage. -The necessity of the stains must be justified with specific documentation within the surgical pathology report, detailing why the stains were performed and the results obtained. *Specifics of the LCD L36805 (WPS): -This policy emphasizes that reflex templates or pre-orders for special stains and IHC stains before reviewing the routine hematoxylin and eosin (H&E) stain by the pathologist are not considered reasonable and necessary. -Only the pathologist may determine the need for special stains after reviewing the routine H&E stain. -Exceptions include recognized standards of care in certain biopsies and the suspicion of infectious diseases. *Specifics of the LCD L35922 (Palmetto): -Like WPS, Palmetto’s policy requires detailed documentation of the medical necessity for special stains or IHC studies and their results in the pathology report. -The policy delineates scenarios where over-utilization or incorrect billing of these stains may occur, such as the use of pre-orders for special stains without prior review of the H&E stain. Implications for Pathologists and Healthcare Providers These determinations highlight the critical role of pathologists in ensuring that the use of special stains and IHC stains is both necessary and properly documented. Healthcare providers must ensure compliance with these guidelines to secure Medicare coverage for these diagnostic tests. Proper documentation and communication with treating physicians are paramount to adhere to these new standards. For further details, you can review the complete LCDs on the CMS website using the following LCD IDs: L36805 and L35922. #Medicare #Healthcare #Pathology #MedicalNecessity #IHCStains #SpecialStains #Palmetto #WPS

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Hospice providers: are you ready for PECOS Changes? Starting today, new PECOS regulations are in effect, mandating that all certifying and attending physicians must be PECOS certified. Non-compliance will lead to the denial of hospice claims. Join #TeamAxxess at our webinar this Thursday to understand these changes and their significant impact on claims processing. Add it to your calendar here: https://ow.ly/E3rL50S48xX #hospice #PECOS

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🔓 Unlock the power of Hospice Dynamix's Predictive Length of Stay (PLOS) for your referral network! 🔎 With this innovative tool, you can quickly and easily identify the depth of your referral network, monitor the impact of each referral source category on your census development and sustainability, and proactively assess the quality of admissions from each referral source type, all in real-time. 🚀 Don't wait - take control of your referral network and optimize your patient population today with Hospice Dynamix! Schedule a demo here 👉 https://lnkd.in/gHtuvXcq Check out this brief video to learn more📽

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🌟 New Blog Alert! 🌟 Hospice care is often misunderstood, leading to delays in accessing crucial support. In our latest blog post, we debunk common misconceptions surrounding hospice care and emphasize the importance of starting it sooner. Don't miss out on valuable insights and tips to ensure a dignified and comfortable end-of-life journey. Click the link to read more! 📖👇 https://loom.ly/60vM0Ec #HospiceCare #EndOfLife #Misconceptions #Support #ReadMore

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The new HOPE tool introduces significant changes for hospice https://ow.ly/XnJC50RRBWL what's new to ensure a smooth transition for your hospice agency. Learn more – https://ow.ly/RXBN50RRBWM #HOPE #CMS #Hospice #Healthcare #PostAcute #HomeCare #Infographic #Blog #MaxwellHCA #MHA #MHADifference

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🔎 More goGetters in the wild! Adam Packett is at the LeadingAge PA Annual Conference showcasing how goHappy is helping senior living communities not only improve engagement with their staff, but also with their families and residents. 📖 Check out this case study to see how Charter Senior Living is using goHappy to improve engagement and benefits enrollment. https://lnkd.in/dzPrXu8b #frontlineworkers #employeeengagement

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Many questions arise during in your #SeniorLiving search, from finances to amenities and activities. And you might have found yourself wondering, "Is senior living worth it?" Read our blog to learn more and discover why senior living it is: https://bit.ly/3KtxNhM

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Reminder: Our "Navigating Senior Living" webinar with VHC Health is TOMORROW! Don't miss out on valuable insights into senior living options. Register now! https://lnkd.in/dqMjueYs #SeniorLiving #Webinar #Tomorrow #SilverBridgesConsulting

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According to the Small Business Administration (SBA), there are four basic steps to developing the information you need to start a small business. I agree with these basic steps and recommend all nurses interested in business complete this exercise. Over on the #NNBA blog I've rewritten these steps to be more applicable to nurses, so head over there to complete this exercise. https://lnkd.in/gtAtGxQY #nurses #nursesinbusiness #businesstips #nurseentrepreneurs #nnba2024

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As your loved one navigates a life-limiting illness, hospice care can often feel like a choice of defeat. A common hospice myth is that choosing hospice care means you’re giving up on your loved one. In reality, hospice care has a unique and powerful way of enriching and improving quality of life. That’s why at Ethos Hospice, we’re committed to spreading awareness while shining light on just how beautiful hospice care can be.

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Are you newer to the caregiver registry business? Here are some essential terms you need to know: https://hubs.ly/Q02x1TM70

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