ASC Coding, Billing & Collections

Blue Cross Blue Shield Michigan has clarified their policy surrounding a modifier applied to certain outpatient surgical codes.  In February, BCBS Michigan released a new reimbursement policy surrounding modifier 25. In the initial announcement, BCBS stated that beginning May 1,…

Six South Texas physicians and their practices agreed to pay $4.9 million to resolve allegations they submitted false claims to Medicare, Medicaid and TriCare for services that were not rendered or not medically necessary, according to a March 2 news…

Across five orthopedic procedures—including two that were added to the Covered Procedures List for 2026— ASCs consistently post lower total costs than hospital outpatient departments — in some cases by more than $6,000 per case — driven largely by lower…

Roya Jafari-Hassad, MD, was sentenced to seven years of imprisonment for prescribing oxycodone pills without a legitimate medical purpose and fraudulently billing insurance providers for procedures that were never performed, according to a March 2 news release from the U.S.…

A new study published in JAMA found that a new Medicare add-on billing code boosted pay significantly for specialists. The study analyzed Medicare claims data from 2024, the first year that the G22111 was introduced. The code was billed 26…

Lawmakers have extended the Acute Hospital Care at Home waiver through 2030, which will grant waivers to individual hospitals who provide Medicare patients with inpatient-level home care.  Hospital-at-home has gained steady traction in recent years as health systems work to…

Contract negotiations between ASCs and payers are becoming increasingly complex as both sides sharpen their strategies in a tighter reimbursement environment. ASC leaders describe a landscape in which insurers are flexing scale, data analytics and network design to contain costs…

In a recent advisory opinion, the Office of Inspector General ruled a specific urgent care management service organization’s plan to run an affiliated clinical lab would not create prohibited “remuneration” under the federal Anti-Kickback Statute, according to a Feb. 26…

For many ambulatory surgery center leaders, anesthesia has quietly become the fault line where financial and clinical realities intersect. What was once a stable, predictable service line is now one of the most dynamic sources of both risk and opportunity.…

Vice President JD Vance and CMS Administrator Mehmet Oz, MD, announced a series of actions affecting Medicare and Medicaid, including a $259.5 million deferral of federal Medicaid funding in Minnesota and a six-month moratorium on new Medicare enrollment for certain…