For most ASC administrators, getting a major commercial payer to return a phone call about contract negotiations is a victory in itself. Getting two of the country’s largest insurers to sign off on a fundamentally different pricing structure altogether is…
ASC Coding, Billing & Collections
A New York man has been convicted for his role in a $52 million healthcare fraud scheme involving a Brooklyn clinic that illegally distributed Suboxone, paid cash kickbacks to patients and billed Medicare and Medicaid for services never provided, the…
Somewhere between the end of a procedure and the start of the billing process, operative notes often get lost in transit. The physician dictates, the recording goes back to their office, and your ASC’s billing team waits. Sometimes I’ll pull…
CMS recently proposed a rule that would place caps on certain state Medicaid payments in an effort to align them more closely with Medicare rates. Here are nine things ASC leaders need to know about the proposal: 1. The proposed…
Hospitals aren’t the only providers losing ground in Medicare Advantage networks. As the nation’s largest insurers pull back coverage, narrow their HMO offerings, and walk away from contracts they deem unprofitable, some ASCs are feeling the downstream effects. Medicare Advantage…
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Federal agencies are escalating their fight against alleged fraud, waste and abuse in Medicare and Medicaid, deploying funding freezes, new enforcement units and criminal prosecutions. Here are 10 numbers that define the crackdown. $2 billion. The amount CMS could withhold…
Two Massachusetts physicians and their shared practice have been indicted on charges of illegally prescribing controlled substances without legitimate medical purpose and submitting false claims to Medicaid, the Massachusetts Attorney General’s Office said in a May 26 news release. Jeffrey…
Since March 24, the Justice Department has sentenced, accused or settled with four physicians and four durable medical equipment company owner for fraud cases. The activity comes as CMS is currently enforcing a six-month nationwide moratorium on new Medicare enrollment…
A former Connecticut advanced practice registered nurse has been arrested on charges of submitting more than $1.35 million in fraudulent Medicaid claims for medication management services never rendered, the Justice Department said in a May 22 news release. Marisol Rodriguez,…
Prior authorization has been under intense scrutiny in recent months as frustration brews among clinicians and legislators aim to curb the use of AI technology in the practice. Here are five recent developments reshaping the way prior authorization is deployed…