ASC Coding, Billing & Collections

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. 

UnitedHealthcare was delivered a win in May in its legal battle with Knoxville, Tenn.-based physician staffing company TeamHealth. 

Average payments for outpatient burn and wound services were 42.9% below costs across all payers, a May report from the American Hospital Association found.

Matt Kraemer, administrator of Northern Arizona Healthcare in Flagstaff, joined Becker's  to discuss his team's strategy in handling the obstacle of rising overhead paired with stagnating ASC reimbursements.