ASC Coding, Billing & Collections

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…

With site-neutral payment reform poised to reshape the economics of outpatient care, many ASC leaders told Becker’s that the policy could accelerate the shift of procedures away from hospital outpatient departments. While some view the move as a long-overdue step…

The Department of Justice is preparing to investigate a growing number of False Claims Act cases involving skin substitutes, with more cases expected, according to a Feb. 6 blog post from law firm Akin, citing remarks from Deputy Assistant Attorney…

CMS’ decision to phase out the inpatient-only list over three years is expected to accelerate the migration of procedures to outpatient settings, particularly ASCs.  The policy would eliminate a longstanding Medicare rule that restricted reimbursement for certain complex procedures to…

A Kansas anesthesiologist was sentenced to three years in prison for a telemarketing scheme that billed Medicare for medically unnecessary orthotic braces, according to a March 6 news release from the Justice Department.  The move comes after CMS implemented a…

Blue Cross Blue Shield Michigan has clarified their policy surrounding a modifier applied to certain outpatient surgical codes.  In February, BCBS Michigan released a new reimbursement policy surrounding modifier 25. In the initial announcement, BCBS stated that beginning May 1,…