ASC Coding, Billing & Collections

The U.S. House Sept. 23 has unanimously passed a bill allowing mail delivery of prescription drugs to Medicare patients.

On Sept. 24, CMS issued a final ruling to address "significant, anomalous and highly suspect" billing activity on the Medicare Shared Savings program to mitigate financial impacts for Accountable Care Organizations. 

Commercial and government payers alike are increasingly pushing patients to ASCs because of the cost-savings they can offer. 

Physicians could lose at least $25 billion in add-on payments for Part B drugs that could be part of the Inflation Reduction Act's program to negotiate drugs, according to a recent study by Avalere. 

ASCs are facing rising challenges with Medicare Advantage plans, including escalating implant costs, frequent reimbursement denials and increasing administrative hurdles that complicate patient care and financial stability.

As physicians and ASCs face increasing obstacles in securing reimbursements from insurance companies, many are looking to direct-pay or cash models to cut out the need for payers. 

An Alexandria, La.-based physician has been charged for his role in a $32.7 million Medicare fraud scheme involving medically unnecessary definitive urine drug testing services. 

Beginning Jan. 1, Duluth, Minn.-based Essentia Health will no longer be in-network with UnitedHealthcare and Humana Medicare Advantage plans.

A district court dismissed an oncology trade association's challenge to Stark law guidance prohibiting physicians from dispensing drugs in locations outside of their office on Aug. 30.

Here are five updates on Anthem Blue Cross Blue Shield companies, which are owned by Elevance Health, one of the largest payers in the U.S., as reported by Becker's since May 21: