Category: ASC Coding, Billing and Collections

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.

The number of physicians working in private practice is shrinking, as consolidation and rising costs makes practicing independently less feasible. 

Matt Mazurek, MD, assistant professor of anesthesiologist at the New Haven-based Yale School of Medicine, joined Becker’s, to discuss the Stark law issues he’s keeping an eye on. 

The ongoing shift toward value-based payment models has left many healthcare executives weighing the pros and cons of the practice compared to more traditional fee-for-service models.