Category: ASC Coding, Billing and Collections

Migrating procedures to the ASC setting has the potential to save patients, payers and healthcare money.

Stark law has evolved into a complex framework that continues to challenge physicians, and as regulatory changes and enforcement actions escalate, leaders are grappling with how best to comply with these laws. 

Nearly 75% of providers report an increase in claim denials, a 31% jump since 2022, according to the Experian Health’s “2024 State of Claims” survey. 

The future of Stark law is “clouded by uncertainty” after a district court ruled that a false claims lawsuit filed against Thomas Health System cannot be resolved without parties’ briefs on the U.S. Supreme Court’s recent overturning of the Chevron def…

The U.S. House Sept. 23 has unanimously passed a bill allowing mail delivery of prescription drugs to Medicare patients.

On Sept. 24, CMS issued a final ruling to address “significant, anomalous and highly suspect” billing activity on the Medicare Shared Savings program to mitigate financial impacts for Accountable Care Organizations. 

Commercial and government payers alike are increasingly pushing patients to ASCs because of the cost-savings they can offer. 

Physicians could lose at least $25 billion in add-on payments for Part B drugs that could be part of the Inflation Reduction Act’s program to negotiate drugs, according to a recent study by Avalere. 

ASCs are facing rising challenges with Medicare Advantage plans, including escalating implant costs, frequent reimbursement denials and increasing administrative hurdles that complicate patient care and financial stability.

As physicians and ASCs face increasing obstacles in securing reimbursements from insurance companies, many are looking to direct-pay or cash models to cut out the need for payers.