A Tennessee nurse practitioner has been convicted of illegally prescribing nearly a million opioid pills to almost 1,000 patients at a rural pain clinic, the Justice Department said in a June 2 news release. Heather Marks, of Murfreesboro, prescribed oxycodone…
ASC Coding, Billing & Collections
Steve Hockert, chief development officer at Southlake, Texas-based Solara, has been warning the ASC industry for years that outcomes data would become the great differentiator, and now, with CMS mandating patient experience reporting and public scorecards going live in 2026,…
The former CEO and a former sales executive of a Massachusetts laboratory have agreed to pay $1.2 million to resolve False Claims Act allegations of paying illegal kickbacks to physicians disguised as managed service organization distributions to induce laboratory test…
UnitedHealthcare is set to remove nearly two-thirds of prior authorization requirements for pediatric services across a number of specialties, according to a May 29 news release from the company. Here are five things to know:
The federal No Surprises Act has become a flashpoint for physician groups and payers alike as the law’s independent dispute resolution process draws criticism due to costly inefficiencies and other process issues. Here are eight updates on the NSA and…
Advertisement
For most ASC administrators, getting a major commercial payer to return a phone call about contract negotiations is a victory in itself. Getting two of the country’s largest insurers to sign off on a fundamentally different pricing structure altogether is…
A New York man has been convicted for his role in a $52 million healthcare fraud scheme involving a Brooklyn clinic that illegally distributed Suboxone, paid cash kickbacks to patients and billed Medicare and Medicaid for services never provided, the…
Somewhere between the end of a procedure and the start of the billing process, operative notes often get lost in transit. The physician dictates, the recording goes back to their office, and your ASC’s billing team waits. Sometimes I’ll pull…
CMS recently proposed a rule that would place caps on certain state Medicaid payments in an effort to align them more closely with Medicare rates. Here are nine things ASC leaders need to know about the proposal: 1. The proposed…
Hospitals aren’t the only providers losing ground in Medicare Advantage networks. As the nation’s largest insurers pull back coverage, narrow their HMO offerings, and walk away from contracts they deem unprofitable, some ASCs are feeling the downstream effects. Medicare Advantage…