Category: ASC Coding, Billing and Collections

A gastroenterologist in Central Islip, N.Y., pleaded guilty March 7 to billing Medicare for millions of dollars for medical procedures that weren’t performed, according to the Justice Department.

The Surgery Center of Oklahoma in Oklahoma City is leading the charge in ASC price transparency with its all-cash model, according to a March 4 D Magazine report. 

Commercial payers account for 55 percent of total collections at ASCs, according to VMG Health’s “Multi-Specialty ASC Benchmarking Study” for 2022.

Commercial payers account for an average of 44 percent of total cases in ASCs, according to VMG Health’s “Multi-Specialty ASC Benchmarking Study” for 2022.

CMS has sent about 342 warning notices to hospitals found noncompliant with price transparency regulations since Jan. 1, 2021, when the rule went into effect. 

Blue Cross Blue Shield of Texas customers no longer have in-network access to physicians and facilities of Houston-based health system Memorial Hermann, The Examiner reported March 3.

Seventy-nine percent of medical groups say that payer prior authorization requirements increased in the last year, according to a poll conducted by Medical Group Management Association March 1.

Variations of colonoscopies make up three of the 10 most common procedures performed at an ASC, according to data company Definitive Healthcare.

Cigna, one of the country’s largest payers, has named two executives in the last month. 

Health insurer chief executives earn millions of dollars each year while their companies narrow networks and lower pay rates for physicians and ASCs.