ASC Coding, Billing & Collections

The number of physicians working in private practice is shrinking, as consolidation and rising costs makes practicing independently less feasible. 

Matt Mazurek, MD, assistant professor of anesthesiologist at the New Haven-based Yale School of Medicine, joined Becker's, to discuss the Stark law issues he's keeping an eye on. 

The ongoing shift toward value-based payment models has left many healthcare executives weighing the pros and cons of the practice compared to more traditional fee-for-service models.

The Justice Department's new pilot program, which rewards whistleblowers who provide evidence of corporate misconduct, could lead to an uptick of whistleblower activity related to private payer fraud, The National Law Review reported Aug. 15

Most physicians expressed disapproval of relative value unit-based pay in Medscape's 2024 "Physicians and RVUs Report." 

On Aug. 1, CMS released the nearly 3,000-page final rules on reimbursement and other inpatient issues, according to an Aug. 7 blog post by Coronis Health. 

Differences in reimbursement between ASCs and HOPDs are an ongoing pain point for surgery centers. However, many opportunities to profit off of specialty procedures remain, regardless.

Physicians are eyeing Stark law as the Department of Justice doubles down on enforcement, with an uptick in complaints-in-intervention and Stark-related settlements. 

As of 2023, nearly half of U.S. hospital and health systems have at least one partnership, affiliation, or ownership interest in ASCs. Reports from industry publications indicate ASCs are becoming central to the overall financial strategy of extensive healthcare service…

More than 80% of surgeries are now performed in an outpatient setting, according to the Ambulatory Surgery Center Association.  ASC procedures are almost always less expensive than in hospital outpatient departments.