Consolidation among health insurers has damaging effects on independent physician practices and their patients, according to the American Medical Association’s new report, “Competition in Health Insurance: A Comprehensive Study of U.S. Markets.” AMA researchers analyzed data from 2024 across 384…
ASC Coding, Billing & Collections
Lafayette, La.-based Priority Hospital Group, three of its managed long-term care hospitals and a physician are facing allegations of violations of the False Claims Act tied to medically unnecessary care and improper patient referrals, according to a Jan. 21 news…
Fee-for-service Medicare payments per beneficiary receiving care at ASCs rose sharply over the past year, increasing 13.1% from 2023 to 2024, according to MedPAC Medicare carrier claims data published Jan. 15. Here are fee-for-service Medicare payments per beneficiary receiving ASC…
Stark law enforcement is intensifying as the Justice Department recovered a record $6.8 billion under the False Claims Act and regulators continue refining key exceptions that shape how physicians structure financial relationships. Here are eight developments to watch this year.…
CMS’ decision to phase out the Medicare Inpatient Only list in 2026 marks a consequential site-of-service policy that could rapidly accelerate the migration of complex procedures to outpatient settings while introducing new risks around safety, access and payer behavior. Under…
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ASC leaders say payers too often treat outpatient surgery centers as “optional” sites of care, rather than essential providers that deliver hospital-level quality at a fraction of the cost. Two leaders joined Becker’s to discuss what insurers misunderstand about ASCs. …
ASC leaders say prior authorization has become the most damaging pain point in payer relationships, delaying care even after clinical decisions are made and surgeries are scheduled. Four ASC leaders joined Becker’s to discuss the most frustrating parts of working…
A Maryland man was sentenced to 65 months in federal prison for leading a scheme that used stolen physician identities to submit thousands of fraudulent e-prescriptions for controlled substances, according to a Jan. 14 news release from the U.S. Attorney’s…
In November, CMS finalized its Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule for 2026, which included the addition of 573 codes to the ASC Covered Procedures List. This was a huge win for the Ambulatory…
A McAllen, Texas-based physician and a clinic employee have been sentenced for their roles in a kickback scheme that resulted in more than $3.1 million in Medicare losses, according to a Jan. 13 news release from the U.S. Attorney’s Office.…