Category: ASC Coding, Billing and Collections

As some areas see an uptick in post-procedure claim denials from payers, ASCs may be at a loss on how to salvage payments.

From an ousted CEO to shifting financial expectations, CVS Health-backed insurer Aetna has seen an eventful August. 

Around 36% of physicians earned income from an employment source outside of their practice in 2023, the highest number in five years, according to Medical Economics’ 2024 Physician Report published Aug. 14. 

Financials are important at any business — and ASCs are no exception. However, despite providing the same services, ASCs face unique challenges, such as persistent compensation disparities between ASCs and hospital outpatient departments.

St. Peter’s Health, based in Helena, Mont., agreed to pay $10,844,201 to resolve allegations it violated the False Claims Act by submitting false claims to federal healthcare programs on behalf of a physician formerly employed by the system.

At the end of 2022, CMS proposed an amendment to its overpayment regulations to revise the definition of several terms, including the “identified” definition, specifying when a provider has “knowingly received or retained an overpayment.”

Prior authorizations are considered obstacles by many physicians and patients alike, with 9 in 10 physicians saying in an American Medical Association survey prior authorization has a negative effect on patient outcomes.

Fifty-five percent of physicians spend at least 10 hours a week on prior authorizations, according to Medical Economics’ latest “Physician Report,” published Aug. 14.

Reimbursement disparities have caused discord in the ASC sector — even before 2024’s CMS cuts.

Centene, Humana and UnitedHealthcare have some of the lowest-rated Medicare Advantage plans for customer satisfaction in their markets, according to J.D. Power’s annual Medicare Advantage Study, published Aug. 20.