Insurance giant UnitedHealth Group is facing a lawsuit alleging it used an artificial intelligence algorithm to wrongfully deny coverage to older patients for care under its Medicare Advantage health policies, Bloomberg Law reported Nov. 14.
Category: ASC Coding, Billing and Collections
Value-based care lowers costs, improves patient outcomes: Report
A 2023 report from insurer Humana shows that Medicare Advantage patients receiving care through value-based arrangements spend more time with their physicians and have better care outcomes than their non-value-based counterparts.
Justice Department files motion to dismiss SCA Health antitrust case
The Justice Department filed to dismiss the government’s indictment against Deerfield, Ill.-based ASC chain SCA Health, formerly Surgical Care Affiliates, for allegedly agreeing with competitors to not poach senior-level employees.
59 procedures added to ASC payable list in last 5 years
The CMS ASC payable list has seen sizable change in the last five years — through both additions and removals.
HHS inspector general's latest anitkickback ruling: What ASCs need to know
HHS’ Office of Inspector General has issued an advisory opinion on a new safe harbor to kickback laws that aims to increase quality while reducing costs, according to a Nov. 14 article in JDSupra from law firm WilmerHale.
What to know about Stark law & physician referrals
HHS’ Office of Inspector General released its General Compliance Program Guidance on Nov. 6, providing an overview on Stark law and physician referrals.
The burden of prior authorizations: 5 key stats
Eighty-nine percent of providers said that prior authorizations were very or extremely burdensome, according to the Medical Group Management Association’s 2023 “Regulatory Burden Report.”
Physicians and Stark law: 5 leaders' thoughts
Stark law settled a record-breaking $9.2 million in voluntary self-referral disclosure settlements in 2022, and many physician leaders have experienced obstacles stemming from Stark law policy.
Prior authorization delaying 97% of providers' necessary care
Ninety-seven percent of providers’ patients have received delays or denials for necessary care due to prior authorization requirements, according to the Medical Group Management Association’s 2023 “Regulatory Burden Report.”
Geisinger joins Capital Blue Cross Medicare Advantage network
Danville, Pa.-based Geisinger has been added to Capital Blue Cross’ Medicare Advantage network, beginning Jan. 1, according to a Nov. 9 report from The Valley Ledger.
