ASC Coding, Billing & Collections

In a recently released white paper titled “The Nation’s Challenge to Combat Durable Medical Equipment Fraud in Medicare,” HHS Office of Inspector General details three fraud vectors it says are fueling Medicare’s crackdown on durable medical equipment suppliers.  The report…

Regulators haven’t touched the Stark law’s core rules in years, but enforcement hasn’t slowed down.  Record False Claims Act recoveries, a surge in whistleblower suits and a growing wave of self-disclosures all point to a compliance environment that’s only getting…

Five cases involving physicians and physician-adjacent fraud schemes have surfaced in a single month, collectively totaling more than $195 million in alleged fraud, settlements and indictments.  Here are the five cases: 1. Chesapeake Regional Medical Center has reached a tentative…

Trends in Anesthesia Financial Support for Ambulatory Surgery Centers Until recently, there were a few virtual certainties in anesthesia: hospitals required financial support for anesthesia coverage, while ambulatory surgery centers (ASCs) did not. That distinction has changed dramatically, and ASC…

For nearly as long as health insurers have used prior authorization to control costs, physicians and hospitals have argued it does more harm than good.  The pushback against prior authorization has reached new heights in recent months as healthcare leadership,…

For nearly 40 years, the J-1 visa, which lets international medical graduates train in U.S. residency programs, has helped hold together the physician workforce in some of the country’s most underserved communities.  Now, the same pipeline health system leaders have…

CMS finalized its newest mandatory bundled payment model for hospitals, but the rule also has implications for ASCs that perform outpatient hip and knee replacements for those hospitals’ patients. The Comprehensive Care for Joint Replacement Expanded Model, or CJR-X, was…

A Tennessee-based in-home care company has agreed to pay $2.4 million to resolve False Claims Act allegations of submitting false diagnosis codes to inflate Medicare Advantage risk scores, the Justice Department said in an Aug. 24 news release. Monogram Health…

Underneath every conversation about ASCs taking on total joints, spine and cardiac cases is CMS and a handful of state legislatures rewriting the rules that used to keep those cases in the hospital. “As CMS moves toward site-neutral, single-payment policy,…

A man has been charged with healthcare fraud for allegedly practicing medicine without a license at a New York medical practice for more than eight years, submitting fraudulent claims to Medicare and Medicaid under a licensed physician’s name and provider…