• Florida physician pleads guilty to antitrust conspiracy that limited cancer options

    Oncologist William Harwin, MD, former president and managing partner of Fort Myers-based Florida Cancer Specialists & Research Institute, has pleaded guilty in a conspiracy to allocate oncology treatments for cancer patients. 
  • Cigna Healthcare cuts 25% of prior authorization requirements

    Cigna Healthcare is removing nearly 25 percent of medical services from prior authorization requirements, cutting more than 600 codes. 
  • Insurer-health system breakups: 3 cases to know

     Here are three health system and payers splits since May: 
  • California legislature takes action to eliminate prior authorization

    The California legislature is considering a bill that would prohibit prior authorizations for any healthcare service if the plan or insurer approved or would have approved not less than 90 percent of the prior authorization requests a provider submitted in the most recent completed one-year contracted period.
  • Physicians could be in financial danger with this Stark law change 

    Physician groups who provide certain medical equipment, devices and supplies to their Medicare patients could be in violation of Stark law following the end of the COVID-19 public health emergency, attorneys from law firm Epstein Becker & Green wrote in an Aug. 14 JDSupra article. 
  • Commonwealth Health's physician group can't enforce noncompete law on former surgeon

    A judge has ruled that Commonwealth Health's physician group, Commonwealth Physician Network, cannot prevent its former surgeon from working locally for Geisinger, The Times-Tribune reported Aug 21. 
  • UHC Texas adds 4 medications to Medicaid prior authorization list

    Beginning Sept. 17, UnitedHealthcare Texas will begin requiring prior authorization for four medications based on new state guidelines for Texas' Medicaid program. 
  • US representative launches investigation into Medicaid prior authorization denials

    Rep. Frank Pallone Jr., a Democrat from New Jersey, has announced an inquiry into the high rate of prior authorization denials by Medicaid managed care plans. 
  • Noncompete changes ramp up in 2023 

    Changes in noncompete agreements, which prohibit physicians from joining a competing practice or setting up their own within a particular distance from their previous practice for a certain period of time, are ramping up in 2023 as states amend their laws. 
  • The cost of the 25 most common ASC procedures 

    Extracapsular cataract removal without endoscopic cyclophotocoagulation is the most common procedure performed at ASCs, according to recent data from Definitive Healthcare. 
  • Healthcare contract labor expenses by region

    As physician and administrative shortages remain high, many health facilities are pivoting to contract labor to bolster their care teams. 
  • What happens if physician pay continues to decline?

    In July, CMS announced its suggested 3.34 percent conversion factor decrease in its proposed Medicare physician fee schedule for 2024. This proposal, coupled with inflation and low reimbursement rates, could put an additional strain on physicians' compensation and healthcare overall.
  • The biggest headaches for physicians working with Medicaid patients

    About 43 percent of physicians receive more claim denials with Medicaid patients than other patients, according to Medscape's 2023 "Doctors Working with Medicaid" report published Aug. 9, which includes survey results from 251 practicing U.S. physicians who currently accept Medicaid patients. 
  • 5 reimbursement stats and trends ASCs should know

    Here are five physician reimbursement statistics and trends that ASCs should know: 
  • 25 most common ASC procedures by number of charges 

    Cataract removal was the most common ASC procedure by the total number of charges in 2022, according to July 26 data from Definitive Healthcare. 
  • How much time do physicians spend on prior authorization?

    In 2022, 39 percent of physicians spent one to nine hours on prior authorizations weekly, according to Medical Economics' "94th Physician Report" released Aug. 4.
  • Does prior authorization actually reduce costs?

    The administrative costs of healthcare, including prior authorizations, are estimated to make up 20 to 34 percent of healthcare expenditures, according to an Aug. 4 report from the American Enterprise Institute, a public policy think tank.
  • Some payers cut prior authorizations, others double down

    2023 has been a tumultuous year when it comes to prior authorizations, as some payers have repealed major barriers to procedures, while others have added new rules. 
  • 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.
  • Negotiating favorable payer contracts: 'huge challenge' for ASCs

    Successful negotiations and favorable contracts with payers is the first step before surgical centers can sustainably function and grow, and navigating this process can be difficult and time-consuming.

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