In October, CMS announced the launch of a new prior authorization demonstration that would introduce new requirements for select services. This comes just four months after news of an agreement between CMS and Medicare Advantage plans to lessen the use…
ASC Coding, Billing & Collections
Payer and employer pressure to lower healthcare costs is accelerating the shift of surgical procedures into ambulatory surgery centers, according to Jeffrey Flynn, COO of Gramercy Healthcare and president of the New York State Association of Ambulatory Surgery Centers. Mr.…
Austin, Texas-based Advanced Pain Care and its founder Mark Malone, MD, have agreed to pay $13.6 million to resolve allegations of submitting false claims to federal and state healthcare programs for urine drug testing, the Justice Department said in a…
A federal grand jury indicted California-based Done Global and Florida-based Mindful Mental Wellness for their alleged roles in a scheme to illegally distribute Adderall and commit healthcare fraud, according to a Dec. 16 news release from the Justice Department. What…
A New York physician was sentenced Dec. 9 for receiving kickbacks in exchange for ordering medically unnecessary brain scans, according to a Department of Justice news release. What happened?
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ASCs are entering 2026 in a tough spot: pay updates are landing, but many leaders say they’re still being squeezed by inflation, payer tactics and rising procedure complexity. Five dynamics, in particular, are shaping the ASC reimbursement picture heading into…
A Missouri man was sentenced to 10 years in prison for orchestrating a Medicare fraud scheme that generated more than $174 million in genetic testing claims, according to a Dec. 12 news release from the U.S. Department of Justice. What…
A New York physician was sentenced to seven years in prison for his role in a scheme that resulted in more than $24 million in fraudulent claims to Medicare, according to an Oct. 23 Justice Department release. What happened?
More than 400,000 Cigna Healthcare members in Arizona could lose access to Tenet Healthcare’s Phoenix-based Abrazo Health network if the two organizations fail to reach a new agreement by the end of the year, the Phoenix Business Journal reported Dec.…
Most ASC leaders Becker’s spoke with summed up the 2025 payer environment in a single word: challenging. Four of the five leaders pointed to intensifying prior authorization and referral requirements, rising denials, and shrinking reimbursement, all as supply and operating…