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Commercial payer spend on GI procedures in HOPDs vs. ASCs — 6 statistics
Consumers save as much as $5 billion a year in out-of-pocket costs by having procedures performed in ASCs instead of hospital outpatient departments, according to Anthem. -
NY clinic leader ordered to pay $39.4M, gets prison sentence for role in kickback scheme: 5 details
The former leader of multiple New York medical clinics was sentenced to prison and ordered to pay millions for his involvement in a money laundering and healthcare kickback scheme, according to a report from the Department of Justice. -
2021 CPT code set includes 329 modifications — 4 things to know
The American Medical Association released the 2021 Current Procedural Terminology code set Sept. 1. -
Anthem: Shifting certain GI procedures to ASCs could create $12B in savings
Colonoscopies and upper gastrointestinal procedures cost an average of 1.7 times more in a hospital outpatient department than they cost in an ASC, according to a July report from Anthem's Public Policy Institute. -
Tennessee state health plans allegedly overpaid providers at least $17.58M
State health plan administrators BlueCross BlueShield of Tennessee and Cigna allegedly overpaid providers at least $17.58 million, according to a claims data analysis by private firm ClaimInformatics, the Times Free Press reports. -
Chicago surgery center improves financial performance
Rush SurgiCenter Chicago saw its financial performance increase after using the SNBilling revenue cycle management service, according to a study released by Surgical Notes. -
4 kickback settlements since April
During the pandemic, several settlements have been reached in lawsuits involving devicemakers, drug companies and physician groups. -
Surgery groups vs. insurers: 4 court battles to know
Four recent lawsuits involving surgical groups and insurance companies: -
ASCs don't want to be out of network in an economic downturn: 3 thoughts from a VP
John Kelly, senior vice president of strategic planning at advertising agency 9Rooftops Health, shared three thoughts on the future of the ASC market: -
Physician practices should avoid these 5 billing mistakes
Seemingly minor billing mistakes can result in major revenue losses for physician practices, according to the Pensacola Voice. -
Total charges in 2019 for the 10 costliest ASC procedures
Some of the most expensive procedures performed in ASCs last year represented over $40 million in total charges, according to Definitive Healthcare. -
Imaging provider sues Cigna for nearly $400K over allegedly improper denials
A new lawsuit accuses Cigna of violating the Coronavirus Aid, Relief and Economic Security Act by improperly denying nearly $400,000 in COVID-19-related claims, according to Law360 and Radiology Business. -
North Carolina ASC reports PPP loan was overstated
An ASC in Wilmington, N.C., reported that the U.S. Small Business Administration overstated how much money it received from the Paycheck Protection Program, according to the StarNews. -
Cigna loses motion to dismiss ASC suit over 'systematic,' 'indiscriminate' claim denials
Cigna's motion to dismiss a lawsuit brought by South Amboy, N.J.-based Metropolitan Surgical Institute was partially denied, according to a document filed July 31 in the New Jersey District Court. -
'We want people to understand why we're upset' — 5 surgery, specialty group leaders on CMS' proposed 2021 fee schedule
CMS released its Medicare Physician Fee Schedule proposed rule for 2021 Aug. 3, which could result in drastic cuts for surgeons across the board. -
What CMS' proposal to eliminate the inpatient only list means for ASCs
There are currently around 1,740 procedures on CMS' inpatient only list, which is reviewed and updated annually. However, CMS proposed eliminating the inpatient only list in 2021 after years of receiving comments advising the agency to allow physicians to decide on the clinical site of service. -
CMS proposes making it easier for some physician-owned hospitals to expand: 4 details
CMS proposed removing some provisions in the expansion exception process for physician-owned hospitals that serve high numbers of Medicaid inpatients in the 2021 Outpatient Prospective Payment System proposed rule. -
11 procedures CMS may add to the ASC payable list in 2021 + a new review process for 2022
CMS proposed adding 11 procedure codes to the ASC payable list, including total hip replacement, according to ASCA. -
CMS could increase ASC reimbursement by 2.6% — 5 insights
CMS released its proposed hospital outpatient payment rule for 2021 that would increase ASC reimbursement rates about 2.6 percent if approved as drafted. -
CMS proposes cutting Medicare payments for some specialty surgeries 6%-9%
CMS released its Medicare Physician Fee Schedule proposed rule for 2021 Aug. 3, which made several drastic cuts to payment rates for both general and specialty surgeons.
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