ASC Coding, Billing & Collections

For nearly as long as health insurers have used prior authorization to control costs, physicians and hospitals have argued it does more harm than good.  The pushback against prior authorization has reached new heights in recent months as healthcare leadership,…

For nearly 40 years, the J-1 visa, which lets international medical graduates train in U.S. residency programs, has helped hold together the physician workforce in some of the country’s most underserved communities.  Now, the same pipeline health system leaders have…

CMS finalized its newest mandatory bundled payment model for hospitals, but the rule also has implications for ASCs that perform outpatient hip and knee replacements for those hospitals’ patients. The Comprehensive Care for Joint Replacement Expanded Model, or CJR-X, was…

A Tennessee-based in-home care company has agreed to pay $2.4 million to resolve False Claims Act allegations of submitting false diagnosis codes to inflate Medicare Advantage risk scores, the Justice Department said in an Aug. 24 news release. Monogram Health…

Underneath every conversation about ASCs taking on total joints, spine and cardiac cases is CMS and a handful of state legislatures rewriting the rules that used to keep those cases in the hospital. “As CMS moves toward site-neutral, single-payment policy,…

A man has been charged with healthcare fraud for allegedly practicing medicine without a license at a New York medical practice for more than eight years, submitting fraudulent claims to Medicare and Medicaid under a licensed physician’s name and provider…

Chesapeake Regional Medical Center has reached a tentative agreement with the Justice Department to resolve a criminal case stemming from the hospital’s decades-long relationship with convicted OB-GYN Javaid Perwaiz, MD, 13 News Now reported Aug. 19. Under the tentative agreement,…

Physicians who once worked in a physician-owned practice before their current job are significantly more likely than their peers to be heading for the exit, according to the 2026 PAI Employed Physician Survey. Among physicians with prior experience in a…

ASC leaders have been increasingly vocal about the miscalculation of treating the center as one enterprisewide profit-and-loss statement instead of a collection of distinct businesses, each with its own economics.  As reimbursement tightens and cost structures shift, some of the…

Eight in 10 ENT physicians say a proposed CMS payment cut could reduce seniors’ access to care, with more than two-thirds saying they would need to see fewer Medicare patients and 14% saying they would stop accepting Medicare entirely, according…