A national sales director from Port Jefferson, N.Y., has pleaded guilty to a scheme involving kickbacks to physicians in exchange for ordering unnecessary brain scans, resulting in $70.6 million in fraudulent Medicare claims, according to an April 2 news release…
ASC Coding, Billing & Collections
Gastroenterology has the highest percentage of block time utilization at ASCs, according to ASC software company HST Pathways’ latest “State of the Industry Report.“ Here’s the percentage of block time used at ASCs, by specialty, in 2024, according to data…
Rep. Mark Green, MD, a Republican from Tennessee, reintroduced a bill to Congress that would reform prior authorization requirements, The Hill reported March 27. “As a survivor of both colon and thyroid cancer, I know how critical it is to…
Healthcare consultant Gregg Gordon, who launched Surgical Solutions IPA in 2024, recently joined Becker’s to discuss how payers have “historically undervalued the ASC model,” and what it will take to shift that dynamic. Mr. Gordon, who has worked on both…
On Feb. 25, President Donald Trump signed an executive order targeted at boosting healthcare price transparency. Here are five other notes on the conversation surrounding price transparency for ASC leaders and physicians under the second Trump administration: 1. The order…
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Lenexa, Mo.-based Minimally Invasive Surgery Hospital has filed a lawsuit against Cigna, alleging the insurer failed to pay $1.34 million in claims, Kansas City Business Journal reported March 27. . What happened? Becker’s has reached out to Cigna and will…
Prior authorization rates are increasing at ASCs, according to HST Pathways’ latest “State of the Industry Report.” The report surveyed 590 ASCs in 47 states. Here are five more insights to know: 1. In 2024, 46% of cases completed preauthorizations,…
A federal jury has convicted a Kentucky physician, among other parties, for his role in a scheme to defraud Medicare and Kentucky Medicaid via Kentucky Addiction Centers, according to a March 26 news release from the Justice Department. What happened? …
ASCs are seeing a slight increase in case cancellations, averaging a 21% cancellation rate in 2024 — up from 20% in 2023, according to HST Pathways’ latest “State of the Industry Report.” Here are four more insights: 1. Seventy-seven percent…
A March 14 MedPAC report found that while certificate-of-need laws are a major factor in ASC development, other state-specific factors, such as healthcare payment models and demographics, can blunt their effects. Here are five things to know certificate-of-need laws and…