ASC Coding, Billing & Collections

Orthopedics tops the pack for ASC revenue per case, according to VMG Health's "Multi-Specialty ASC Benchmarking Study" for 2022. The specialty was only the fourth most-represented among ASC cases, however.

From the dismissal of the inpatient-only list to the removal of procedures from the ASC-payable list, CMS plays a massive role in the success of an ASC.  

Thirty-four percent of physicians reported that delays in processing a prior authorization led to a serious adverse event for a patient in their care, according to a recent survey from the American Medical Association. 

UnitedHealthcare now requires members to obtain prior authorization before undergoing physical and occupational therapy at multidisciplinary offices and outpatient hospitals in four states.

Chicago-based insurance provider UnitedHealthcare has ended its requirement in most plans for providers to submit an observation notification after a patient is discharged home, the company said Feb. 10.

Payers UnitedHealthcare, Cigna and Anthem reported the largest year-end revenue in 2021. 

Two Laredo, Texas-based physicians were among 10 indicted in a $300 million healthcare fraud scheme Feb. 10, according to the Justice Department.

The No Surprises Act, the federal law requiring ASCs and physician practices to provide cost estimates to self-pay patients, went into effect Jan. 1. 

ASCs and physician practices are required to provide cost estimates for expected charges to self-pay patients when scheduling procedures or services as part of the No Surprises Act, which went into effect Jan. 1.

Here are five updates from Aetna, one of the country's biggest payers, in the last 30 days: