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Site-neutral insurer contracts a reality for orthopedic group
Surgery centers have advocated for site-neutral payments with hospital outpatient departments, so the same rates are paid regardless of where the procedure is performed. -
Hospital interests pushing CMS away from ASCs, administrator says
CMS has passed several measures in the last year affecting ASC reimbursements, including removing 255 procedures from the ASC-payable list. For Cathy McCue, MSN, RN, administrator of Uropartners Surgery Center in Des Plaines, Ill., CMS' actions point to a prioritization of hospitals because of a strong hospital lobby. -
Insurers want more surgeries in ASCs
Snagging profitable payer contracts and high reimbursements has historically been an obstacle for ASCs, particularly when competing with hospitals' big pockets. -
Hospitals seek 15% pay bump from insurers — what should ASCs ask for?
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. -
Financial opportunities in ASCs and how to capitalize on them — 3 takeaways
Growth opportunities across the ambulatory surgery center (ASC) space continue. -
Maine physician group to cut ties with Anthem over 5 years of flat rates
Portland, Maine.-based independent practice Fore River Urology is cutting its contract with Anthem, Bangor Daily News reported May 3. -
ASC sues UnitedHealthcare for failure to cover surgery
Advanced Surgery Center in Fort Lee, N.J., has filed a lawsuit against UnitedHealthcare for allegedly failing to pay for hernia-related procedures. -
13% of denied prior authorizations met Medicare requirements, HHS says
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 send mixed signals to ASCs, physicians
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 harder to get surgeries approved. -
Physician to pay $4.5M for Medicare fraud at California clinics: 5 details
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. -
4 ASC leaders' thoughts on value-based care
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. -
5 CMS updates
Here are five updates from CMS in the last two weeks: -
50+ stats on ASC operating costs
Here are more than 50 stats about ASC operating expenses from VMG Health's 2022 "Multi-Specialty ASC Benchmarking Study:" -
Surgical Notes adjusting leadership teams after client base tripled in last 12 months
ASC billing services provider Surgical Notes is promoting several senior managers after the company's client base more than tripled over the last 12 months. -
Mnet Health, One Medical Passport rebrand
Mnet Health, a revenue cycle management and technology provider, and One Medical Passport, a Mnet company have rebranded as One Mnet Health. -
39 stats on ASC revenue
Here are 39 stats about ASC revenue from VMG Health's 2022 "Multi-Specialty ASC Benchmarking Study:" -
Insurer under fire for millions in unpaid claims
Anthem has captured the attention of multiple hospitals and health systems across the U.S. as allegations of underpayment and inappropriate denials accumulate. -
The price-transparent marketplace startup inspired by an ASC
Healthcare e-commerce startup Fair Market Health was dreamed up when a group of physicians from Wichita, Kan., decided they wanted to replicate the patient and provider benefits of a cash-based Oklahoma City ASC, Wichita Business Journal reported April 13. -
CMS answers queries on No Surprises Act & 6 more updates
CMS recently answered questions about requirements of the No Surprises Act and about giving good faith estimates to uninsured and self-pay patients. -
ASCs want to ditch insurers
Physician groups and surgery centers are increasingly cutting insurers from the care delivery equation and contracting directly with employers and cash-paying patients.
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