The Department of Justice is preparing to investigate a growing number of False Claims Act cases involving skin substitutes, with more cases expected, according to a Feb. 6 blog post from law firm Akin, citing remarks from Deputy Assistant Attorney…
ASC Coding, Billing & Collections
CMS’ decision to phase out the inpatient-only list over three years is expected to accelerate the migration of procedures to outpatient settings, particularly ASCs. The policy would eliminate a longstanding Medicare rule that restricted reimbursement for certain complex procedures to…
A Kansas anesthesiologist was sentenced to three years in prison for a telemarketing scheme that billed Medicare for medically unnecessary orthotic braces, according to a March 6 news release from the Justice Department. The move comes after CMS implemented a…
Blue Cross Blue Shield Michigan has clarified their policy surrounding a modifier applied to certain outpatient surgical codes. In February, BCBS Michigan released a new reimbursement policy surrounding modifier 25. In the initial announcement, BCBS stated that beginning May 1,…
Six South Texas physicians and their practices agreed to pay $4.9 million to resolve allegations they submitted false claims to Medicare, Medicaid and TriCare for services that were not rendered or not medically necessary, according to a March 2 news…
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Across five orthopedic procedures—including two that were added to the Covered Procedures List for 2026— ASCs consistently post lower total costs than hospital outpatient departments — in some cases by more than $6,000 per case — driven largely by lower…
Roya Jafari-Hassad, MD, was sentenced to seven years of imprisonment for prescribing oxycodone pills without a legitimate medical purpose and fraudulently billing insurance providers for procedures that were never performed, according to a March 2 news release from the U.S.…
A new study published in JAMA found that a new Medicare add-on billing code boosted pay significantly for specialists. The study analyzed Medicare claims data from 2024, the first year that the G22111 was introduced. The code was billed 26…
Lawmakers have extended the Acute Hospital Care at Home waiver through 2030, which will grant waivers to individual hospitals who provide Medicare patients with inpatient-level home care. Hospital-at-home has gained steady traction in recent years as health systems work to…
Contract negotiations between ASCs and payers are becoming increasingly complex as both sides sharpen their strategies in a tighter reimbursement environment. ASC leaders describe a landscape in which insurers are flexing scale, data analytics and network design to contain costs…