ASC Coding, Billing & Collections

Eighty-one percent of medical groups have seen an increase in prior authorization requirements since 2020, according to a poll conducted by the Medical Group Management Association in May.

An optometrist based in Carlisle, Mass., was indicted for billing fraud during the height of the pandemic.

Melbourne, Fla.-based Surgery Center of Viera filed a lawsuit Jan. 20 in Florida Middle District Court in Orlando against Cigna and Strategic Enterprise Solutions.

Both payers and CMS have noticed opportunities in value-based care to lower costs and strengthen patient care. 

Here are the major reimbursement updates since July 1: 

Value-based care and bundled payments have been gaining momentum in the ASC industry as a means to reduce healthcare costs and improve patient care. 

Surprise bills for colonoscopies following a stool-based screening test with positive results are now prohibited, according to Health Day. 

New York City-based insurance company Oscar Health introduced a price transparency tool that allows members to compare specific expenses for procedures at ASCs, hospitals and other settings.

Tri-State Specialists in Sioux City, Iowa, will pay hundreds of thousands of dollars to resolve billing fraud allegations.

Cigna is one of the oldest and largest payers in the U.S. with 20.4 million members.