• 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    2023 has been a tumultuous year when it comes to prior authorizations, as some payers have repealed major barriers to procedures, while others have added new rules.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.
  • Noncompete agreements: What physicians should know in 2023

    Here are seven things physicians should know about noncompetes in 2023 so far: 
  • St. Louis physician accused of fraud 

    St. Louis-based physician Sonny Saggar, MD, was arrested on an indictment accusing him of healthcare fraud, the U.S. Justice Department said July 27. 
  • Physicians are fed up with prior authorization. Here's what they want.

    Prior authorization has continued to be a thorn in the sides of physicians nationwide. 
  • UnitedHealthcare to reduce prior authorization by 20%

    On Sept. 1, UnitedHealthcare will begin a two-phased approach to eliminate prior authorization requirements for several procedure codes. 
  • This trend could reduce the number of ASCs

    Anesthesia costs are skyrocketing, and some ASCs are worried about sustainability of these issues if payer reimbursements do not adjust. 
  • The obstacle stifling ASC growth

    Certificate-of-need laws vary by state and consequently can have a huge impact on ASC development in each region.
  • 'Not much squeezing left to be done': Why ASC reimbursements need to increase

    Some leaders believe payers will be forced to increase ASC reimbursements as they become more lucrative amid healthcare's shift to value-based care. 
  • Value-based care could be ASCs' secret to success 

    As a low-cost site of service, ASCs could benefit as value-based care's influence in healthcare heightens. 
  • How 4 CMS updates from this month will impact ASCs

    July has been a busy month for CMS, from facing Congressional pressure on a prior authorization overhaul to the addition of dental surgical codes in its prospective payment system proposal for 2024. Here is how four changes floated in the last 30 days will impact ASCs: 
  • 4 major insurers facing lawsuits

    Here are four major insurance companies, including UnitedHealthcare and Aetna, facing lawsuits in the last 60 days: 
  • How do physicians feel about noncompetes? 

    Noncompete clauses affect between 37 and 45 percent of physicians, according to a report from the American Medical Association, and often can limit career growth and restrict physicians' ability to provide care in economically or socially marginalized communities. 
  • Cigna sued over new AI-powered claims system

    Healthcare and insurance company Cigna is facing a lawsuit alleging that it systematically rejects patient claims using an algorithm system it put in place to automate the process, according to a July 24 report from Forbes.
  • Illinois physician, ASC to pay $760K to settle fraud allegations 

    Suburban Chicago physician John Greager, MD, and his ASC will pay more than $757,000 to settle allegations he submitted fraudulent claims to Medicare and the Federal Employees Health Benefits Program.  
  • Congress continues to press CMS over prior authorization improvement

    A bipartisan Congressional majority is putting pressure on CMS to finalize a federal regulation that would overhaul prior authorization within Medicare Advantage, according to a July 24 report from the American Medical Association.
  • Stark law changes ramp up in 2023

    Here are four Stark law changes Becker's has reported on since Feb. 15:

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