ASC Coding, Billing & Collections

The burden of prior authorization is growing as "payers seek new strategies to reduce outlays," according to a June 24 blog post from Coronis Health. 

The federal government is targeting New York City-based Mount Sinai Health System's inclusion of noncompete clauses in contracts for part-time physicians in a June 18 complaint filed with the National Labor Relations Board. 

The Federal Trade Commission's ban on noncompete clauses is facing a preliminary injunction from a federal court in Texas. 

Medicare Advantage plans have garnered animosity from providers due to the restrictive approval processes for needed services.

The Justice Department charged 193 people, including 76 physicians, for their alleged roles in fraud schemes nationwide.

CMS has updated its coverage requirements for ASCs, The Joint Commission said in a June 26 news release.

As scrutiny increases on payer prior authorizations, health plans are using a new tactic to disrupt provider cash flows: post-procedure clawbacks.

Here are five numbers illustrating the effect prior authorization regulations and reform efforts have on healthcare:

Denials for outpatient care claims jumped 16% in the last three years, while inpatient care claims rose 26%, according to a May 21 report from Kodiak Solutions. 

Some leaders have become increasingly frustrated with hospital outpatient department reimbursements far outpacing ASCs, but there are efforts at the federal level to move toward site-neutral payments.