ASC Coding, Billing & Collections

ASC leaders far and wide agree payers have the upper hand in reimbursement negotiations, but each has their own take on which particular set of tactics is doing the worst damage to the economics of outpatient surgery. From rates that…

Stark law, originally enacted in 1989 to curb physician self-referrals, but decades later, many physicians argue the law has calcified into a rigid framework outdated to the way modern healthcare actually works.  Designed to protect patients from conflicts of interest,…

Two Missouri physicians are facing a False Claims Act complaint regarding alleged improper billing using the RST-Sanexas neoGEN-series electric stimulation device, the Justice Department said in a March 12 news release.  The complaint targets St. Louis, Mo.-based chiropractor Michael Glickert,…

Facility fees have become a controversial component of the reimbursement structure for ASCs as some advocates say they disincentivize patients from utilizing lower cost settings for surgical procedures.  “I call it a double whammy,” Kara Newbury, chief advocacy officer for…

For patients facing low health literacy and significant social determinants of health challenges, navigating the healthcare system can be difficult even under the best circumstances. But according to Esme Singer, MD, chief medical officer of Philadelphia-based Temple Faculty Physicians at…

The Medicare Payment Advisory Commission released its annual report to Congress March 12, which revealed key data points about the sustained growth of the ASC industry and the U.S’s overall healthcare spending. Here are 15 takeaways from the report: 1.…

There is an ongoing dispute between hospital and health plan leaders in North Carolina over the use of “facility fees” in outpatient billing, NC Newsline reported March 12.  Last year, the Senate passed a bill that would restrict facility fees…

For many ASCs, implants have become a difficult expense to manage, often requiring large upfront payments while reimbursement remains inconsistent. “Implants and surgical supplies are the most consistently misaligned ASC expense,” Peter Bravos, MD, chief medical officer of Sutter Health’s…

Chattanooga, Tenn.-based Erlanger Health System must defend against two False Claims Act lawsuits after a federal judge denied the system’s bids to dismiss the cases. Here are 10 things to know: 1. Erlanger is facing two related False Claims Act…

While CMS’ addition of 573 codes to the ASC Covered Procedures list has been cause for celebration for many leaders, a Medicare policy affecting coinsurance payments for certain procedures may be disincentivizing patients from using ASCs and creating barriers to…