Category: ASC Coding, Billing and Collections

Physician found guilty in $12M Tricare fraud scheme

Arkansas physician Joe May, MD, was convicted on 22 counts over his involvement in a scheme to defraud Tricare of $12 million, the Justice Department said June 10.

Optum, Anthem invest in value-based care: What ASCs need to know

Optum Ventures, CVS Ventures, Anthem and HLM Venture Partners announced they are investing in CareBridge, a value-based care company for patients receiving home and community-based services. 

Michigan physician pleads guilty to fraudulent billing, to pay $500K

A Muskegon, Mich., physician has pleaded guilty to billing Medicare, Medicaid and Blue Cross Blue Shield for services she didn’t perform, the U.S. Justice Department said June 7. 

‘Our business model would implode’: Why a physician group exited a payer’s network

David Kowalski, MD, a physician with Springfield (Ill.) Clinic, a physician group with ASCs that dropped out of network with Blue Cross Blue Shield of Illinois last year after a pay dispute, shed light on the details of the dispute and what lies ahead …

ASCs find new strategies to avoid reimbursement woes

Many ASCs are facing increasing obstacles in the payer landscape, but ASC administrators and executives are developing strategies like direct-to-employer contracting and attracting patients to bypass them. 

WakeMed’s UnitedHealthcare contract ends, but ASCs are unaffected

After months of negotiations, Raleigh, N.C.-based WakeMed and UnitedHealthcare failed to reach an agreement on a new contract, The News and Observer reported June 1.

Physician group severs contract with Anthem & 5 more payer updates

From a Maine physician group ending its contract with Anthem to Blue Cross Blue Shield updating its colonoscopy policy, here are six payer updates from the last 60 days:

Why orthopedic ASCs, physician groups should get on the direct-to-employer train

As the healthcare industry continues to move away from fee for service and toward value-based care, alternative payment models are expected to become more popular among patients, insurers and providers.

ASCs can win with this major trend

With the trends in healthcare moving toward value-based care models, ASCs could be in the perfect position for growth. 

3 suits filed against UnitedHealth: What ASCs need to know

Three lawsuits have been filed against healthcare giant UnitedHealth Group and UnitedHealthcare in the last month — including two ASCs filing suits.