Category: ASC Coding, Billing and Collections

Certificate-of-need laws vary by state and consequently can have a huge impact on ASC development in each region.

Some leaders believe payers will be forced to increase ASC reimbursements as they become more lucrative amid healthcare’s shift to value-based care. 

As a low-cost site of service, ASCs could benefit as value-based care’s influence in healthcare heightens. 

July has been a busy month for CMS, from facing Congressional pressure on a prior authorization overhaul to the addition of dental surgical codes in its prospective payment system proposal for 2024. Here is how four changes floated in the last 30 days …

Here are four major insurance companies, including UnitedHealthcare and Aetna, facing lawsuits in the last 60 days: 

Noncompete clauses affect between 37 and 45 percent of physicians, according to a report from the American Medical Association, and often can limit career growth and restrict physicians’ ability to provide care in economically or socially marginalized …

Healthcare and insurance company Cigna is facing a lawsuit alleging that it systematically rejects patient claims using an algorithm system it put in place to automate the process, according to a July 24 report from Forbes.

Suburban Chicago physician John Greager, MD, and his ASC will pay more than $757,000 to settle allegations he submitted fraudulent claims to Medicare and the Federal Employees Health Benefits Program.  

A bipartisan Congressional majority is putting pressure on CMS to finalize a federal regulation that would overhaul prior authorization within Medicare Advantage, according to a July 24 report from the American Medical Association.

Here are four Stark law changes Becker’s has reported on since Feb. 15: