Brentwood, Tenn.-based SpecialtyCare and two affiliated physician groups sued two Anthem health plans, alleging the insurers failed to pay about $2.5 million in No Surprises Act independent dispute resolution awards, according to an Oct. 16 complaint reviewed by Becker’s. The…
ASC Coding, Billing & Collections
A Johnson County, Kan., health software CEO has been sentenced to 19 years in prison for running a platform that generated false physician orders used to bill Medicare and other federal health programs more than $1 billion, according to an…
The number of provider groups receiving federal independent dispute resolution decisions on ambulatory surgery center claims nearly doubled to 2,580 in 2025, up from 1,324 in 2024, according to an analysis from Sunlight. Sunlight drew on CMS Federal IDR Public…
CMS made 22 surgical procedure codes newly payable in ASCs through its 2026 quarterly updates, according to an analysis of the agency’s April, July and October ASC payment updates. The agency also made four codes nonpayable and replaced one. Here…
CMS has added 10 new procedure codes to the list of procedures Medicare pays ASCs to perform, according to an Oct. 8 transmittal outlining the agency’s October 2026 ASC payment system update. The highest-paying addition, code 1091T for permanent carotid…
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The No Surprises Act was built to take patients out of the middle of out-of-network billing fights. The arbitration process it created to settle those fights between insurers and providers has since become a fight of its own. Over the…
Centene is the latest national insurer to roll out a prior authorization gold card program, joining UnitedHealthcare and Humana. For ASCs, the catch is where the exemption lands: in most programs, the gold card belongs to the surgeon’s practice, not…
Stamford, Conn.-based physician Steven Murphy, MD, and his practices, Murphy Medical Associates and Diagnostic and Medical Specialists of Greenwich (Conn.), have agreed to pay $866,539 to resolve allegations of COVID-19-related and healthcare fraud, according to an Oct. 16 news release…
CMS has approved B. Braun Medical’s Stimuplex Single-Shot Nerve Block Needles for separate Medicare payment under the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act, effective retroactively to April 30. The devices qualify as non-opioid medical devices under the law,…
Pay in 17 of 30 physician specialties failed to keep up with inflation in 2026, according to a Sept. 29 analysis from Marit Health. Consumer prices rose 3.4% in the 12 months ending in August, according to the Bureau of…