The No Surprises Act was designed to protect patients from unexpected medical bills. Four years into its implementation, the law’s independent dispute resolution process has generated new financial hurdles for physician groups. Fort Worth-based Radiology Associates of North Texas recently…
ASC Coding, Billing & Collections
A proposed CMS rule published in May would reduce Medicaid spending by more than $775 billion over 10 years, a figure that has dominated hospital finance conversations for weeks. Although Medicaid populations skew toward hospital-based care, and most ASC payer…
CMS published its interim final rule for Medicaid work requirements June 1, setting the stage for a significant shift in who qualifies for Medicaid coverage. Under HR 1, most able-bodied, nonpregnant Medicaid recipients between ages 19 and 64 must work,…
Musculoskeletal surgeries performed in ASCs are projected to generate $13.5 billion in Medicare fee-for-service savings from 2025 to 2034, overtaking digestive system procedures to become the second-largest specialty by program savings, according to an analysis of KNG Health data published…
ASCs generated $27.9 billion in Medicare savings between 2019 and 2024, according to KNG Health Consulting data prepared for the Ambulatory Surgery Center Association. The federal government’s response has been to keep cutting what it pays them. Federal policy has…
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A Tennessee nurse practitioner has been convicted of illegally prescribing nearly a million opioid pills to almost 1,000 patients at a rural pain clinic, the Justice Department said in a June 2 news release. Heather Marks, of Murfreesboro, prescribed oxycodone…
Steve Hockert, chief development officer at Southlake, Texas-based Solara, has been warning the ASC industry for years that outcomes data would become the great differentiator, and now, with CMS mandating patient experience reporting and public scorecards going live in 2026,…
The former CEO and a former sales executive of a Massachusetts laboratory have agreed to pay $1.2 million to resolve False Claims Act allegations of paying illegal kickbacks to physicians disguised as managed service organization distributions to induce laboratory test…
UnitedHealthcare is set to remove nearly two-thirds of prior authorization requirements for pediatric services across a number of specialties, according to a May 29 news release from the company. Here are five things to know:
The federal No Surprises Act has become a flashpoint for physician groups and payers alike as the law’s independent dispute resolution process draws criticism due to costly inefficiencies and other process issues. Here are eight updates on the NSA and…