Category: ASC Coding, Billing and Collections

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:

Josh Troast, director of ambulatory surgical services for Muskegon (Mich.) Surgical Associates, joined Becker’s to discuss what ASCs need to thrive in the next five years. 

Health Care Service Corp., a health plan operator for 18 million members across Illinois, Montana, New Mexico, Oklahoma and Texas, is integrating artificial intelligence and augmented intelligence to reform its prior authorization process. 

CMS pitched a 2.8 percent average rate increase for ASCs next year, and many leaders feel the move isn’t enough to offset increasing costs. 

Physician pay is struggling to keep up with inflation, declining reimbursement and Medicare pay cuts.