ASC Coding, Billing & Collections

The healthcare industry is entering a transformative era as major legal and regulatory frameworks, including the Stark Law, face significant updates and reinterpretations.

Aetna has filed a lawsuit against Radiology Partners and Mori, Bean and Brooks, RP's Jacksonville, Fla.-based affiliate, alleging a fraud scheme that resulted in overpayments totaling tens of millions of dollars, according to court documents obtained by Becker's. 

In 2024, major developments in insurance and healthcare policies have sparked significant changes affecting ASCs and physicians. 

Here are five numbers for ASC leaders and physicians to know about prior authorization in 2024:

Oroville (Calif.) Hospital agreed to pay $10.25 million to resolve false claims allegations stemming from medically unnecessary inpatient hospital admissions, a kickback and physician self-referral scheme and erroneous diagnosis code use.

Here are 26 moves by payers for ASC leaders and physicians to know in 2024:

Here are three recent updates on prior authorization for ASC physicians and leaders to know:

On Nov. 26, CMS proposed reforms to the Medicare Advantage and Part D programs for contract year 2026, including changes to prior authorization and GLP-1 coverage. 

ASCs are facing a trifecta of pay issues — anesthesia stipends, rising expenses and stagnant reimbursements. 

Many ASCs have voiced support for site neutrality, which would create parity between ASC and hospital reimbursements, yet has been met with pushback from hospitals.