ASC Coding, Billing & Collections

Washington lawmakers advanced the most significant Medicare Advantage prior authorization reform in years this week. But as Congress moves to curb delays and denials for beneficiaries enrolled in private Medicare plans, CMS is simultaneously expanding prior authorization in traditional Medicare…

UnitedHealthcare’s frustration with the No Surprises Act’s arbitration system became explicit on the insurer’s second-quarter earnings call, but it is only the most recent escalation in a fight that has stalled in Congress, lost repeatedly in federal court and is…

Billing and payment are among the most complex aspects of day-to-day administrative work for ASC leaders — and it’s rarely due to the ASC itself. Ellen Rostron, business operations manager at Boston Out-Patient Surgical Suites, told Becker’s that a common…

A group of physician lawmakers has introduced the Patients First Act, which revamps the Medicare physician fee schedule, expands access to care and improves incentives for independent practices.  Here are eight notes on the new legislation, according to a July…

CMS’ proposed Medicare payment policy includes another 1.68% cut to reimbursements for surgeons.  The CMS calendar year 2027 Medicare Physician Fee Schedule’s proposed rule could have an even larger effect on spine and orthopedics. Specialty-level analysis estimates that orthopedic surgery…

On July 14 CMS  issued a proposed rule outlining Medicare Part B payment policy changes for physicians and other practitioners under the calendar year 2027 Physician Fee Schedule, including a 1.68% decrease in the proposed conversion factor for non-qualifying alternative…

EyePoint Pharmaceuticals has agreed to pay the U.S. government $4,657,463.18 to resolve False Claims Act allegations tied to its ophthalmic drug DEXYCU. According to a July 17 news release by the Justice Department, the Waltham, Mass.-based company allegedly paid kickbacks…

A two-paragraph provision in North Carolina’s new state budget has left oral health advocates uncertain about its implications for Medicaid coverage of dental procedures performed at ASCs, North Carolina Health News reported July 17. Five notes:

While ASCs have seen significant growth in recent years as CMS approves more procedures for the outpatient setting, technology advances and patient preferences shift — insurer policies and practices remain a key obstacle to ASC growth and sustainability.  Two ASC…

An operation can go exactly as planned and still become a bad surgical episode. The patient leaves the hospital, then falls at home. Pain or swelling sends them to the emergency department. A rehabilitation stay stretches longer than expected. A…