ASC Coding, Billing & Collections

CMS has proposed a mandatory bundled payment model expansion for lower extremity joint replacements under the FY 2027 Hospital Inpatient Prospective Payment System proposed rule. The proposed Comprehensive Care for Joint Replacement Expanded, or CJR-X, model would apply nationwide to…

Helen Boerman, OD, an optometrist in Brentwood, Tenn., pleaded guilty to defrauding Medicare of $6.9 million.  Dr. Boerman used her practice, Brentwood Eye Care, to submit about $11 million in false Medicare claims, and she received nearly $7 million, according…

Elevance Health’s out-of-network provider penalty policy has drawn sharp legislative backlash and opposition from hospitals and physician groups across the country.  Here are seven things ASCs leaders and physicians should know: 1. How the penalty works. In-network facilities that use…

Payer denials remain a persistent problem across the hospital industry, but Nashville, Tenn.-based Tenet Healthcare, parent company of ASC chain United Surgical Partners International, isn’t seeing the acceleration that has rattled some of its peers, CEO Saumya Sutaria, MD, said…

A Huntington Park, Calif., physician and his medical practice agreed to pay more than $6.73 million to resolve False Claims Act allegations of performing medically unnecessary vascular procedures on Medicare beneficiaries, the Justice Department said in a May 6 news…

As CMS expands its coverage of procedures in ASCs and technology continues to advance what is possible in the outpatient setting, leaders must carefully balance risk, cost and logistics to meet the moment of ASC development.  Two ASC leaders recently…

From operating room utilization to patient outcomes and supply chain costs, ASCs must closely monitor a range of performance data to deliver on their value proposition as a low-cost, high-efficiency alternative to inpatient surgery. But many ASCs still struggle with…

A Texas physician has been convicted by a federal jury of unlawfully distributing more than a million pills of opioids and other controlled substances through a cash-only Houston strip mall clinic, the U.S. Drug Enforcement Administration said in a May…

Two physician lawmakers introduced legislation to replace the Merit-based Incentive Payment System. Reps. Mariannette Miller-Meeks, MD, a Republican from Iowa, and Herb Conaway Jr., MD, a Democrat from New Jersey, introduced the Medicare Physician Data-Driven Performance Payment System Act, which…

Two Georgia men have been sentenced for their roles in a scheme to submit more than $522 million in fraudulent claims to Medicare, Medicaid and private insurers for medically unnecessary genetic tests, the Justice Department said in a May 5…