ASC Coding, Billing & Collections

ASCs in many markets are struggling for leverage with payers, up against massive hospital systems and sparse cost information from the insurance companies. 

A federal jury has ruled that insurance brokerage Lockton Cos. and two brokers will pay $3 million to USI Insurance Services for allegedly breaching noncompete agreements, Business Insurance reported July 23. 

For many ASCs, navigating payer behavior and declining reimbursements is the biggest challenge in maintaining profits. 

Physicians and other healthcare providers should keep a sharp eye on potential Stark law allegations amid increasing federal scrutiny, law firm Arnold & Porter wrote in an April blog post. 

As many as nine out of 10 physicians say that prior authorization has a negative effect on patient outcomes, according to the American Medical Assocation's survey of about 1,000 physicians nationwide.

The Department of Justice is doubling down on Stark law enforcement, with an uptick in complaints-in-intervention and Stark-related settlements, law firm Arnold & Porter wrote in an April blog post. 

Palo Alto, Calif.-based oncology company Guardant Health will pay $913,933 to settle allegations it violated Stark Law. 

The Federal Trade Commission is investigating DaVita and Fresenius Medical Care, two of the country's largest dialysis providers, over allegations their noncompete clauses illegally stifle smaller competitors, Politico reported July 13. 

Here are six updates on Medicare Advantage that have made headlines recently, as reported by Becker's since June 25:

Reimbursement differences between hospital outpatient departments and ASCs are a longstanding point of contention among ASC professionals, with Medicare ASC payments increasing only marginally while Medicare hospital pay has seen comparatively significant jumps.