ASC Coding, Billing & Collections

ASCs are facing rising challenges with Medicare Advantage plans, including escalating implant costs, frequent reimbursement denials and increasing administrative hurdles that complicate patient care and financial stability.

As physicians and ASCs face increasing obstacles in securing reimbursements from insurance companies, many are looking to direct-pay or cash models to cut out the need for payers. 

An Alexandria, La.-based physician has been charged for his role in a $32.7 million Medicare fraud scheme involving medically unnecessary definitive urine drug testing services. 

Beginning Jan. 1, Duluth, Minn.-based Essentia Health will no longer be in-network with UnitedHealthcare and Humana Medicare Advantage plans.

A district court dismissed an oncology trade association's challenge to Stark law guidance prohibiting physicians from dispensing drugs in locations outside of their office on Aug. 30.

Here are five updates on Anthem Blue Cross Blue Shield companies, which are owned by Elevance Health, one of the largest payers in the U.S., as reported by Becker's since May 21:

ASC software solutions provider HST Pathways has partnered with revenue cycle management services company Synergen Health. 

CMS' Medicare Merit-based Incentive Payment system has new reporting options to fulfill traditional MIPS requirements.

MedHQ, a provider of advisory and administrative services for ASCs in the U.S., has acquired Trajectory Revenue Cycle Services. 

As some areas see an uptick in post-procedure claim denials from payers, ASCs may be at a loss on how to salvage payments.