Category: ASC Coding, Billing and Collections

ASC sues UnitedHealthcare for failure to cover surgery

Advanced Surgery Center in Fort Lee, N.J., has filed a lawsuit against UnitedHealthcare for allegedly failing to pay for hernia-related procedures.

13% of denied prior authorizations met Medicare requirements, HHS says 

Thirteen percent of denied prior authorization requests made by Medicare Advantage organizations met Medicare coverage rules, according to a review conducted by the HHS Office of Inspector General released in April. 

Insurers send mixed signals to ASCs, physicians

Insurers are sending mixed messages to ASCs and independent physicians. On one hand, they want surgery centers and physicians to stay independent to keep costs low; on the other, they are increasing prior authorizations and denial policies that make it…

Physician to pay $4.5M for Medicare fraud at California clinics: 5 details

Donald Woo Lee, MD, was sentenced to 93 months in prison and ordered to pay more than $4.5 million for his role in a Medicare fraud scheme, the U.S. Justice Department said April 28.

4 ASC leaders’ thoughts on value-based care

Value-based care is gaining traction in the ASC industry as CMS and payers see opportunities in bundled payments over traditional fee-for-service models. 

5 CMS updates

Here are five updates from CMS in the last two weeks:

50+ stats on ASC operating costs

Here are more than 50 stats about ASC operating expenses from VMG Health’s 2022 “Multi-Specialty ASC Benchmarking Study:”

Surgical Notes adjusting leadership teams after client base tripled in last 12 months

ASC billing services provider Surgical Notes is promoting several senior managers after the company’s client base more than tripled over the last 12 months.

Mnet Health, One Medical Passport rebrand

Mnet Health, a revenue cycle management and technology provider, and One Medical Passport, a Mnet company have rebranded as One Mnet Health.

39 stats on ASC revenue 

Here are 39 stats about ASC revenue from VMG Health’s 2022 “Multi-Specialty ASC Benchmarking Study:”