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,…
ASC Coding, Billing & Collections
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…
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,…
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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…
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…
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…