• CMS settles $9.2M in Stark law self disclosures: 3 things to know

    CMS settled a record number of 104 Stark law self disclosures in 2022, totaling more than $9.2 million, according to a Sept. 18 JDSupra report from law firm McGuireWoods. 
  • The Stark law change targeting an 'out-of-control' physician issue

    CMS recently passed a Stark law update that will allow hospitals and healthcare providers to improve mental health services for physicians.
  • ASC Claim Denial Study: Effective Solutions for Top 3 Denial Reasons

    Serving over 1,100 surgical clients nationwide for over twenty years, nimble solutions has unique insight into the claim denial reasons for ambulatory surgery centers (ASCs). Our business intelligence and analysis team recently conducted a comprehensive study to explore the most common denial reasons for ASCs and the root cause of those denials. The study analyzed clearinghouse data from ASCs nationwide for the year-to-date period ended June 2023.
  • The Stark law issues physicians are eyeing

    Four physicians joined Becker's to discuss the Stark law trends they are eyeing. 
  • HOPDs charge up to 58% more than ASCs

    The cost of common medical procedures are as much as 58 percent more expensive when performed in hospital outpatient departments compared with ASCs or physicians' offices, according to an analysis by the Blue Cross Blue Shield Association. 
  • What's on the horizon for value-based care in ASCs?

    Value-based care has become one of the most-used buzzwords in healthcare. But how does it apply to ASCs? 
  • 8 payer moves ASCs need to know

    Here are eight updates on six of the U.S.' largest payers that ASC leaders should know:
  • Strategies to Minimize Denials in Musculoskeletal Procedures

    As the ASC landscape continues to evolve, so does the challenge of claim denials. As part of our commitment to providing practical solutions for our clients, nimble’s analytics team conducts on-going studies to address the most common claim denial reasons.
  • New CMS rule to target opioid usage in ASCs

    As part of its 2022 end-of-the-year spending package, Congress passed the NOPAIN Act, set to take effect in 2025, that will set up a separate Medicare payment for certain non-opioid pain management approaches in outpatient and ASC settings, according to a Sept. 11 report from the Baltimore Sun.
  • FTC continues to target noncompetes: 5 things to know

    The 7th Circuit Court of Appeals remanded a district court's dismissal of an antitrust case that could have implications for noncompete agreements, according to a Sept. 8 JDSupra article from law firm Shearman & Sterling. 
  • AHA weighs in on CMS' proposed ASC payment system

    The American Hospital Association, which represents 5,000 member hospitals, health systems and other healthcare organizations, has submitted a letter to CMS commenting on its proposed hospital outpatient prospective payment system and ambulatory surgical center payment system rules for calendar year 2024. 
  • Here's what 10 physician specialties bill to commercial payers every year

    On average, physician specialists bill $3.8 million annually to commercial payers, but some specialties, including orthopedic surgery and urology, bill well over that amount, according to data from AMN Healthcare's 2023 "Review of Physician and Advanced Practitioner Recruiting Incentives" report.
  • Blue Cross Blue Shield of Michigan to reduce prior authorizations by 20%

    Blue Cross Blue Shield of Michigan has announced a new effort to reduce prior authorization requirements by 20 percent in order to improve healthcare quality and access while reducing administrative tasks. 
  • 4 states tackling prior authorization

    From repealing existing prior authorization requirements to adding new ones, here are four states tackling the prior authorization system this year. 
  • Is payer behavior taking away autonomy? This physician says yes

    Physicians are facing rising prior authorization requirements and increasing denials, and some leaders say it is taking away their ability to make decisions. 
  • Payers cutting prior authorizations: 3 major moves to know

    Three major payers have cut prior authorization requirements in August:
  • 3 Stark law updates affecting ASCs

    Here are three Stark law updates that may affect ASCs: 
  • 5 largest payers by market share

    UnitedHealthcare is the largest insurer in the U.S. by market share, according to a July 2023 report from Value Penguin. 
  • The new prior authorization rules going into effect Sept. 1

    On Sept. 1, UnitedHealthcare will begin its two-phased approach to eliminating prior authorization requirements. 
  • Cigna in the headlines: 9 updates in 60 days

    Cigna, the fourth-largest insurer in the U.S. by membership, has received accolades — and scrutiny — in the last two months. 

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