A proposal that would strip Medicare coverage from widely used peripheral nerve block procedures is still active nearly eight months after five Medicare Administrative Contractors published draft local coverage determinations in October. The proposed LCDs would classify therapeutic peripheral nerve…
ASC Coding, Billing & Collections
Pairing a low average cost per case alongside strong outcomes can give independent ASCs a leg up when negotiating contracts with payers. For ASCs that are affiliated with a health system, same-day surgery conversions and site-of-service migration rates can create…
HHS, CMS and the departments of Labor and Treasury finalized a rule May 28 overhauling the No Surprises Act’s independent dispute resolution process, instituting several changes aimed at increasing efficiency and transparency in a process that has been criticized by…
The HHS Office of Inspector General issued an unfavorable advisory opinion this month, concluding that an orthopedic device company’s plan to pay physician consultants royalties tied to product-line revenue posed a heightened risk under the federal Anti-Kickback Statute. Here are…
Matrix Medical Network, a Nashville, Tenn.-based health services company that conducts in-home assessments for Medicare Advantage patients, has agreed to pay $36.5 million to resolve False Claims Act allegations of generating false and invalid diagnoses to artificially inflate risk adjustment…
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The No Surprises Act was designed to protect patients from unexpected medical bills. Four years into its implementation, the law’s independent dispute resolution process has generated new financial hurdles for physician groups. Fort Worth-based Radiology Associates of North Texas recently…
A proposed CMS rule published in May would reduce Medicaid spending by more than $775 billion over 10 years, a figure that has dominated hospital finance conversations for weeks. Although Medicaid populations skew toward hospital-based care, and most ASC payer…
CMS published its interim final rule for Medicaid work requirements June 1, setting the stage for a significant shift in who qualifies for Medicaid coverage. Under HR 1, most able-bodied, nonpregnant Medicaid recipients between ages 19 and 64 must work,…
Musculoskeletal surgeries performed in ASCs are projected to generate $13.5 billion in Medicare fee-for-service savings from 2025 to 2034, overtaking digestive system procedures to become the second-largest specialty by program savings, according to an analysis of KNG Health data published…
ASCs generated $27.9 billion in Medicare savings between 2019 and 2024, according to KNG Health Consulting data prepared for the Ambulatory Surgery Center Association. The federal government’s response has been to keep cutting what it pays them. Federal policy has…