ASC Coding, Billing & Collections

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. 

UnitedHealthcare is one of the country's largest payers.

ASCs are not the only entities that struggle to strike deals with payers. 

Cardiology is one of the fastest-growing ambulatory surgery center (ASC) specialties, and we're seeing the development of new cardiovascular ASCs nationally. Fueling the rise of cardiology in the ASC industry is the addition of different types of cardiovascular procedures to…