CMS now has the power to remove physicians and facilities from federal healthcare programs. HHS Secretary Robert F. Kennedy Jr. delegated permissive exclusion authority to the CMS administrator, effective immediately, according to a notice published in the Federal Register Oct.…
ASC Coding, Billing & Collections
As ASC leaders wait for CMS to release its final 2027 outpatient payment rule, expected in the coming weeks, many are focused on whether the agency will change course on reimbursement. The proposed rule, released July 2, includes a 2.4%…
An ASC’s commercial reimbursement can change even when no one has reopened the contract, according to a payer-contracting consultant. At Becker’s Spine, Orthopedic and Pain Management-Driven ASC Conference 2026 in June, Amy Coletti, a principal at ECG Management Consultants, said…
Most physicians who aren’t qualifying APM participants face a 1.68% cut to the Medicare conversion factor in 2027 under CMS’ proposed physician fee schedule. Some specialties face much steeper drops once coding and valuation changes are added in. The proposed…
Physician employers got two signals this year that seem to conflict. A federal appeals court said common pay practices aren’t evidence of fraud on their own. Six weeks earlier, HHS’ Office of Inspector General said a clean Stark law analysis…
Advertisement
ASCs have less than 15 months before a federal payment for non-opioid pain management products is set to expire, and the 2027 Medicare OPPS/ASC proposed rule does not extend the payment. Here are seven things to know:
A former New Hampshire physiatrist and onetime hospital chief medical officer has been sentenced to 12 months and a day in federal prison for signing hundreds of medically unnecessary orders for braces without ever examining patients, according to an Oct.…
CMS’ 2.5% efficiency adjustment cut work relative value units on about 7,700 non-time-based codes starting Jan. 1. It was a percentage cut that came with a conversion factor increase, so the dollar effect is easy to miss. For physicians paid…
A Falmouth, Mass., man has pleaded guilty to conspiring to launder proceeds of a more than $6 million Medicare fraud scheme run through a New Hampshire medical supply company, according to an Oct. 13 news release from the Justice Department.…
Health plans covered by a federal interoperability rule must begin processing prior authorization requests electronically Jan. 1, but the rule’s reach into ASCs may be limited. It excludes many of the payers ASCs depend on most, and the systems that…