As payer prior authorization requirements grow more complex, ASCs are increasingly caught in what one administrator describes as a “game of chicken” between patient care and financial survival. Elisa Auguste, administrator at East Setauket, N.Y.-based Precision Care Surgery Center and…
ASC Coding, Billing & Collections
A former Saginaw, Mich., physician will be tried on 23 counts of Medicare fraud and false claims, according to a Jan. 22 news release from the Michigan Attorney General. What happened?
Denials, audits and delayed payments are accelerating across ASC, and leaders say payer behavior has become more aggressive, automated and less collaborative over the past year. Five ASC executives joined Becker’s to discuss how they’re adapting, from tightening documentation and…
As employers push patients to lower-cost sites of care and regulators nudge providers toward downside risk, value-based care is moving from theory to reality, and it is coming at “lightning speed,” according to Dan Tasset, founder and chairman of Leawood,…
Medicare Advantage markets remain highly concentrated across the U.S., according to the American Medical Association’s new report, “Competition in Health Insurance: A Comprehensive Study of U.S. Markets.” AMA researchers analyzed data from 2024 across 384 metropolitan areas, all 50 states…
Advertisement
Consolidation among health insurers has damaging effects on independent physician practices and their patients, according to the American Medical Association’s new report, “Competition in Health Insurance: A Comprehensive Study of U.S. Markets.” AMA researchers analyzed data from 2024 across 384…
Lafayette, La.-based Priority Hospital Group, three of its managed long-term care hospitals and a physician are facing allegations of violations of the False Claims Act tied to medically unnecessary care and improper patient referrals, according to a Jan. 21 news…
Fee-for-service Medicare payments per beneficiary receiving care at ASCs rose sharply over the past year, increasing 13.1% from 2023 to 2024, according to MedPAC Medicare carrier claims data published Jan. 15. Here are fee-for-service Medicare payments per beneficiary receiving ASC…
Stark law enforcement is intensifying as the Justice Department recovered a record $6.8 billion under the False Claims Act and regulators continue refining key exceptions that shape how physicians structure financial relationships. Here are eight developments to watch this year.…
CMS’ decision to phase out the Medicare Inpatient Only list in 2026 marks a consequential site-of-service policy that could rapidly accelerate the migration of complex procedures to outpatient settings while introducing new risks around safety, access and payer behavior. Under…