Category: ASC Coding, Billing & Collections

Here are four updates on prior authorization for ASC leaders and physicians to know, as reported by Becker’s so far in 2025:

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A physician in Mission, Texas, was sentenced to 10 years in prison followed by three years of supervised release for carrying out a healthcare fraud scheme involving more than $118 million in false claims.  Jorge Zamora-Quezada, MD, falsely diagnosed his patients with rheumatoid arthritis, ordering unnecessary tests and treatments to defraud Medicare, Medicaid, TRICARE and […]

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As cost pressures intensify, ASCs are increasingly positioning themselves as cost-effective alternatives to hospital settings — especially for high-cost procedures like joint replacements and spine surgery.  For Benjamin Stein, MD, an independent orthopedic surgeon and co-founder of Germantown, Md.-based Capital Surgical Solutions, a new opportunity is arising in direct-to-employer contracting.  “We are seeking novel partnerships […]

The post How this ASC company is forging a new path with employer partnerships appeared first on Becker’s ASC.

While many ASCs rely on analytics platforms embedded in their EMRs or materials management systems, Germantown, Md.-based Capital Surgical Solutions decided to take a different route: building a custom analytics tool from scratch. Benjamin Stein, MD, an independent orthopedic surgeon and co-founder of Capital Surgical Solutions, told Becker’s the decision stemmed from a widespread issue […]

The post Inside the ASC that built its own analytics tool appeared first on Becker’s ASC.

A  wave of medical malpractice reform is reshaping legislation across the country, with four states recently updating their laws, Best Lawyers reported May 19.  According to the report, these reforms reflect a broader trend of tort reform focused on tightening procedural rules, reducing economic exposure for providers and modifying litigation frameworks without necessarily imposing direct […]

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In the past year, ASCs across the country have seen a notable acceleration in payer changes — from tighter reimbursement models and rising costs to an industrywide push toward bundled payments and value-based care.  The more than 28 leaders featured below are speaking at Becker’s 31th Annual: The Business and Operations of ASCs, Oct. 16-18, […]

The post Payer disruption hits ASCs — here’s how 28 leaders are surviving the squeeze appeared first on Becker’s ASC.

Becker’s has reported on two physicians groups who have faced allegations they have violated Stark law in the last week. Here’s what you need to know: Florida eye care group pays $615K for Stark law and kickback violations involving diagnostic referrals  Gulfcoast Eye Care, operating as Pinellas (Fla.) Eye Care, agreed to a $615,000 settlement […]

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Pinellas (Fla.) Eye Care, doing business as Gulfcoast Eye Care, agreed to pay $615,000 to resolve allegations it violated the False Claims Act and Stark law for its billing practices for transcranial doppler ultrasounds, the Justice Department said in a May 16 news release.  What happened?

The post Florida physician practice agrees to pay $615K for Stark law, false claims allegations appeared first on Becker’s ASC.

From sweeping drug price reforms to proposed staffing mandates and changes to Medicaid financing, here are five federal policy moves from the last week that ASCs need to know: CMS proposes updates for third round of Medicare drug price negotiations CMS released draft guidance on May 12 outlining changes for the third round of Medicare […]

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