A Muskegon, Mich., physician has pleaded guilty to billing Medicare, Medicaid and Blue Cross Blue Shield for services she didn't perform, the U.S. Justice Department said June 7. 

David Kowalski, MD, a physician with Springfield (Ill.) Clinic, a physician group with ASCs that dropped out of network with Blue Cross Blue Shield of Illinois last year after a pay dispute, shed light on the details of the dispute and what lies ahead during a presentation at the Effingham (Ill.) County Chamber of Commerce last week.

Many ASCs are facing increasing obstacles in the payer landscape, but ASC administrators and executives are developing strategies like direct-to-employer contracting and attracting patients to bypass them. 

After months of negotiations, Raleigh, N.C.-based WakeMed and UnitedHealthcare failed to reach an agreement on a new contract, The News and Observer reported June 1.

From a Maine physician group ending its contract with Anthem to Blue Cross Blue Shield updating its colonoscopy policy, here are six payer updates from the last 60 days:

As the healthcare industry continues to move away from fee for service and toward value-based care, alternative payment models are expected to become more popular among patients, insurers and providers.

With the trends in healthcare moving toward value-based care models, ASCs could be in the perfect position for growth. 

Three lawsuits have been filed against healthcare giant UnitedHealth Group and UnitedHealthcare in the last month — including two ASCs filing suits. 

Here are five updates from the last 60 day about one the country's largest insurers: 

Medicare per-procedure payments to hospital outpatient departments were 2.1 times larger than payments to ASCs, according to new research published by the Rand Corp. 

Oklahoma Heart Hospital South, a physician-owned hospital based in Oklahoma City, paid $1.2 million to settle billing fraud allegations May 16.

National Medical Billing Services acquired anesthesia, ASC and pain management revenue cycle management provider Medi-Corp, according to a May 17 news release shared with Becker's.

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.

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. 

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.