ASC Coding, Billing & Collections

Aetna, a CVS Health company, is one of the largest insurers, serving roughly 39 million people nationwide. 

Lakeside Orthopedic Institute in Lake Havasu City, Ariz., uses ability and growth to leverage payer contracts. 

Eric Evans, CEO of Brentwood, Tenn.-based Surgery Partners, addressed investor questions about how the CMS 2022 proposed payment rule would affect its ASC business.

Surgical Notes has acquired Zulu Health, an ASC-focused revenue cycle management provider, Surgical Notes said Aug. 3. 

While CMS proposed removing 258 recently added procedures from the ASC-payable list in its 2022 proposed payment rule, another policy change would add some procedures and improve payment for hundreds of others in the outpatient setting.

If finalized, the proposed CMS 2022 Hospital Outpatient Payment Prospective System and ASC Payment System rule may have lasting ramifications for ASCs and the healthcare system.

An Arizona ASC will have to revamp its complaint against Cigna to recover $5.6 million by next month, or it will be dismissed entirely.

ASCs have long struggled to secure reimbursements — with CMS' proposal to remove 258 procedures from the ASC payable list, leaders are concerned that securing payment could become even more challenging. 

Mark Reinford predicts consolidation amongst big payers and consolidation in fee schedules in the payer market in the next five years. 

ASCs often can struggle to leverage payer contracts in comparison to larger hospitals and health systems.