ASC Coding, Billing & Collections

As payers intensify efforts to steer cases to lower-cost settings, ASCs are increasingly becoming a focal point in contracting.  More payers are tying network participation and reimbursement to measures like site-of-care optimization, quality outcomes, patient experience and physician alignment, pushing…

CMS finalized a 2.6% payment increase for ASCs in its November rule, continuing its use of the hospital market basket update, but SCA Health executives warn the technical adjustments in the payment calculation continue to dilute the real-world impact of…

Between 2017 and 2026, annual net inflation adjustments for ASCs have averaged 2.5%, according to a recent VMG Health report, which many ASC leaders say has failed to keep pace with rising costs. “Reimbursement rates have not kept pace with…

The New York State Public Health and Health Planning Council is considering a change to regulations surrounding what procedures can be performed at ASCs, The National Law Review reported Feb. 10.  The change, up for consideration at the legislature’s Feb.…

Rising costs, often connected to inflation, have been cited as one of the top concerns for ASC  leaders in the year ahead—especially when it comes to labor and supplies.  “ASCs are still one of the most efficient sites of care,…

Prior authorization is no longer just an administrative hurdle for ASCs; it is a defining constraint on growth. As authorization requirements expand, policies shift and payer scrutiny intensifies, ASCs are being forced to rethink expansion timelines, staffing models and financial…

The acquisition of ASCs by UnitedHealth Group’s Optum, parent company of ASC chain SCA Health, was associated with double-digit price increases for competing insurers, according to a February study published in Health Affairs. The study examined Optum’s acquisitions of physician…

A Wisconsin durable medical equipment company owner was sentenced to 18 months in prison for conspiracy to pay healthcare kickbacks to physicians according to a Jan. 30 press release. What happened?

A Florida man pleaded guilty for his role in a scheme that defrauded Medicare by submitting over $52 million in false and fraudulent claims for genetic testing and buying physician’s orders, according to a Jan. 15 press release. What happened?

ASCs will continue to receive separate Medicare reimbursement for certain non-opioid pain management devices in 2026 under the NOPAIN Act.  As part of the ruling, CMS confirmed the Game Ready Pro 2.1 cryo-pneumatic compression system was approved for separate payment,…