Category: ASC Coding, Billing and Collections

The healthcare industry is experiencing monumental changes due to policy shifts and the aftermath of COVID-19. Insurers are taking stock of the situation and see a huge opportunity to direct more care to outpatient settings.

An Illinois clinic lost coverage from Blue Cross and Blue Shield of Illinois and an Idaho ASC lost coverage from CMS in 2021. 

Here are seven insights into price transparency and ASCs from the last year:

Potential Medicare pay cuts associated with the 2010 sequestration have loomed large on Capitol Hill for the last decade, but lawmakers continue to kick the can down the road.

Anthem is the largest publicly traded Blue Cross Blue Shield affiliate, operating as a Blue Cross or Blue Cross Blue Shield plan in 14 states. 

Eighty-one percent of medical groups have seen an increase in prior authorization requirements since 2020, according to a poll conducted by the Medical Group Management Association in May.

An optometrist based in Carlisle, Mass., was indicted for billing fraud during the height of the pandemic.

Melbourne, Fla.-based Surgery Center of Viera filed a lawsuit Jan. 20 in Florida Middle District Court in Orlando against Cigna and Strategic Enterprise Solutions.

Both payers and CMS have noticed opportunities in value-based care to lower costs and strengthen patient care. 

Here are the major reimbursement updates since July 1: