Category: ASC Coding, Billing and Collections

As scrutiny increases on payer prior authorizations, health plans are using a new tactic to disrupt provider cash flows: post-procedure clawbacks.

Here are five numbers illustrating the effect prior authorization regulations and reform efforts have on healthcare:

Denials for outpatient care claims jumped 16% in the last three years, while inpatient care claims rose 26%, according to a May 21 report from Kodiak Solutions. 

Some leaders have become increasingly frustrated with hospital outpatient department reimbursements far outpacing ASCs, but there are efforts at the federal level to move toward site-neutral payments. 

UnitedHealthcare was delivered a win in May in its legal battle with Knoxville, Tenn.-based physician staffing company TeamHealth. 

Average payments for outpatient burn and wound services were 42.9% below costs across all payers, a May report from the American Hospital Association found.

Matt Kraemer, administrator of Northern Arizona Healthcare in Flagstaff, joined Becker’s  to discuss his team’s strategy in handling the obstacle of rising overhead paired with stagnating ASC reimbursements. 

ASCs nationwide are facing rising operating costs that are outpacing dwindling reimbursements.

ASCs are struggling to meet margins as procedures continue to migrate to the outpatient setting but reimbursements stagnate. 

The Federal Trade Commission voted 3-2 on April 23 to ban on noncompete clauses for most U.S. workers, and several states have since made moves to restrict noncompetes at the state level.