Independence Blue Cross and Highmark have implemented new policies aimed at reducing healthcare spending by steering certain outpatient procedures from hospitals to lower-cost ASCs, according to a June 14 report by The Philadelphia Inquirer. Philadelphia-based Independence Blue Cross launched its…
ASC Coding, Billing & Collections
Medicare Advantage now covers more than half of all Medicare beneficiaries, and it is built around financial incentives to reduce costs, but it uses ASCs at virtually the same rate as traditional fee-for-service Medicare. That finding, drawn from a KNG…
The Ambulatory Surgery Center Association filed comments June 9 with CMS pushing back against potential inclusion of ASCs in the Transforming Episode Accountability Model, arguing the program is poorly structured for the ASC setting and could slow the migration of…
A San Francisco-based telehealth company and its chief medical officer have agreed to pay $3.325 million to resolve False Claims Act allegations of billing federal healthcare programs and California insurers under the names of providers who did not actually render…
The gap between what ASCs are paid and what hospital outpatient departments receive for identical procedures has become one of the defining financial pressures in outpatient surgery. Here are five numbers that capture the scope of the problem. $56.322 vs.…
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A former Brookline, Mass. physician has been sentenced to 58 months in prison for healthcare fraud, money laundering and tax evasion, the Justice Department said in a June 8 news release. Pankaj Merchia, MD, 52, was convicted in January 2026…
A recent 11th Circuit Court of Appeals ruling clarified how federal prosecutors are able to charge physicians and executives for false statements in healthcare fraud cases, according to a blog post from law firm Armstrong Bradylyons. The case involved an…
The fight between ASCs and payers used to come down to rates. From authorization delays that strand patients in need of surgery to anesthesia reimbursement that treats fixed coverage like a variable cost, ASC leaders say the pressure now runs…
A former chiropractic clinic chain executive has pleaded guilty to filing a false tax return related to an illegal tax shelter used to conceal nearly $1.3 million in taxes, the Justice Department said in a June 5 news release. Stuart…
The No Surprises Act, implemented in 2022, was designed to shield patients from unexpected medical bills and set up an independent dispute resolution process for payers and physician groups to settle out-of-network payments. But the law has become a flashpoint…