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…
ASC Coding, Billing & Collections
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…
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…
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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…
Allstate has filed three federal lawsuits against ASCs and their affiliated providers since mid-April, alleging schemes ranging from kickback arrangements and corporate practice violations to billing for procedures that were never performed. 1. Allstate sued Florida Orthopedics and Neurosurgery, which…
Stark law was written before the internet, EHRs or AI-driven diagnostics existed. But it is still dictating how physicians can structure financial relationships in 2026, and a growing chorus of physicians, legal experts and industry groups say it is time…