ASC Coding, Billing & Collections

Snagging profitable payer contracts and high reimbursements has historically been an obstacle for ASCs, particularly when competing with hospitals' big pockets. 

Hospitals across the U.S. are seeing labor and supply costs rise with inflation and are clashing with insurers about raising contracted rates, according to The Wall Street Journal.

Growth opportunities across the ambulatory surgery center (ASC) space continue.

Portland, Maine.-based independent practice Fore River Urology is cutting its contract with Anthem, Bangor Daily News reported May 3.

Advanced Surgery Center in Fort Lee, N.J., has filed a lawsuit against UnitedHealthcare for allegedly failing to pay for hernia-related procedures.

Thirteen percent of denied prior authorization requests made by Medicare Advantage organizations met Medicare coverage rules, according to a review conducted by the HHS Office of Inspector General released in April. 

Insurers are sending mixed messages to ASCs and independent physicians. On one hand, they want surgery centers and physicians to stay independent to keep costs low; on the other, they are increasing prior authorizations and denial policies that make it…

Donald Woo Lee, MD, was sentenced to 93 months in prison and ordered to pay more than $4.5 million for his role in a Medicare fraud scheme, the U.S. Justice Department said April 28.

Value-based care is gaining traction in the ASC industry as CMS and payers see opportunities in bundled payments over traditional fee-for-service models. 

Here are five updates from CMS in the last two weeks: