ASC Coding, Billing & Collections

HHS' Office of the Inspector General has confirmed broad protection of employee safe harbor under anti-kickback laws in a recent ruling involving physician ownership of an ASC, according to an Oct. 17 article in JDSupra written by law firm Sheppard…

CMS is floating the implementation of a separate add-on payment for healthcare common procedure coding system code G2211 in its 2023 Medicare Physician Fee Schedule, according to an Oct. 13 report in JDSupra written by law firm Reed Smith. 

From negotiating new contracts to expanding plans, here are five moves from these three major payers since Oct. 2: 

Health insurer Cigna has been ordered to pay over $172 million to settle claims that it submitted false diagnosis codes to Medicare Advantage, according to an Oct. 2 report from CBS News.

Cigna healthcare is expanding its Medicare Advantage plans to patients in Nevada for the first time, launching in two counties in the Las Vegas area. 

This year, the U.S. Office of the Inspector General conducted an audit of insurer Aetna's Medicare Advantage program to ensure that selected diagnosis codes Aetna submitted to CMS for use in CMS' risk adjustment program complied with federal requirements. 

Fredericksburg, Va.-based Mary Washington Healthcare will no longer offer Medicare Advantage plans beginning next year, citing rising costs, operational challenges and the impact of COVID-19, according to an Oct. 11 report from The Free Lance-Star.

While PPOs are generally considered beneficial for providers due to the promise of a broader patient base, silent PPOs bring forth an array of hidden pitfalls and challenges they pose for healthcare providers.

Louisville, Ky.-based Baptist Health could be going out of network with UnitedHealthcare for certain Medicare enrollees after its contract with the payer expires on Jan. 1, according to an Oct. 6 report from WDRB.

Cleveland, Ohio-based University Hospitals has launched a co-branded Medicare Advantage Plan for individuals in three Ohio counties in partnership with PrimeTime Health Plan.