Rising costs, often connected to inflation, have been cited as one of the top concerns for ASC leaders in the year ahead—especially when it comes to labor and supplies. “ASCs are still one of the most efficient sites of care,…
ASC Coding, Billing & Collections
Prior authorization is no longer just an administrative hurdle for ASCs; it is a defining constraint on growth. As authorization requirements expand, policies shift and payer scrutiny intensifies, ASCs are being forced to rethink expansion timelines, staffing models and financial…
The acquisition of ASCs by UnitedHealth Group’s Optum, parent company of ASC chain SCA Health, was associated with double-digit price increases for competing insurers, according to a February study published in Health Affairs. The study examined Optum’s acquisitions of physician…
A Wisconsin durable medical equipment company owner was sentenced to 18 months in prison for conspiracy to pay healthcare kickbacks to physicians according to a Jan. 30 press release. What happened?
A Florida man pleaded guilty for his role in a scheme that defrauded Medicare by submitting over $52 million in false and fraudulent claims for genetic testing and buying physician’s orders, according to a Jan. 15 press release. What happened?
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ASCs will continue to receive separate Medicare reimbursement for certain non-opioid pain management devices in 2026 under the NOPAIN Act. As part of the ruling, CMS confirmed the Game Ready Pro 2.1 cryo-pneumatic compression system was approved for separate payment,…
Boston physician Pankaj Merchia, MD, has been convicted on charges of healthcare fraud, money laundering, conspiracy to defraud the IRS and tax evasion, according to a Jan. 23 release from the Justice Department. What happened?
Stark law’s in-office ancillary services exception is one of the most commonly used exceptions because it allows physician practices to provide certain designated health services in the office, such as labs, imaging and therapy, without violating the physician self-referral law,…
Here are 20 recent statistics and updates regarding physician compensation heading into 2026: 1. CMS released its final rule for 2026 Medicare payments under the physician fee schedule, including two separate conversion factors. One for qualified practitioners participating in advanced…
A former Indiana physician has agreed to pay $1.7 million to settle allegations by the Department of Justice that he submitted fraudulent claims to the state Medicaid program, Fox 59 (WXIN-TV) reported Jan. 28. Don Wagoner, MD, allegedly filed over…