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CMS overpaid $636M to ASCs, HOPDs for neurostimulator implantation surgeries, audit finds
The Office of Inspector General found CMS overpaid $636 million for neurostimulator implantation surgeries between 2016 and 2017, according to an audit of outpatient hospital and ASC claims. -
Aetna in the last 60 days: 5 updates
Five updates from Aetna, an insurer serving about 39 million customers nationwide, in the last 60 days: -
Illinois clinic's 100,000 patients could lose Blue Cross coverage after months of contract disputes
Springfield (Ill.) Clinic warned 100,000 Blue Cross and Blue Shield of Illinois-covered patients that they could lose access to their doctors, The State Journal-Register reported Oct. 15. -
Florida ASC sues Aetna over 'mystery repricing program'
Melbourne, Fla.-based Surgery Center of Viera sued Aetna on Oct. 13, according to court documents. The lawsuit alleges that Aetna used an undisclosed "mystery repricing program" to reimburse Viera $33,380 for a July 2018 spinal procedure that the ASC says cost $223,988. -
Time for ASCs to be reimbursed the same as hospitals, Prime Surgeons CEO says
Gil Tepper, MD, founder and CEO of Prime Surgeons in Los Angeles, spoke with Becker's ASC Review on changes he feels CMS should implement to give hospital outpatient departments and ASCs equal footing. -
Stark law clarifies profit allocation for group practices: 5 things to know
The Stark regulations governing group practice rules will change Jan. 1. Business law publication Lexology laid out the new clarifications to group practice profit allocation. -
5 CMS changes ASC leaders want to see
While CMS has made some policies directing surgeries to ASCs, it has also developed regulations ASC leaders see as unnecessary obstacles to outpatient procedure migration. -
Improving the Patient Experience Post-Pandemic – How to Incorporate New Technology and Front-End Offerings
The Covid-19 pandemic has accelerated the adoption of healthcare technologies focused on improving the patient experience while delivering on the expectation of accessible healthcare. -
10% physician pay cut by CMS looms large
The 2022 Medicare Physician Fee Schedule proposed rule includes a large pay cut for physicians to meet the budget neutrality requirements. -
Physician admits to $3.6M billing fraud, pocketing COVID-19 relief funds: 6 details
A New York ophthalmologist pleaded guilty to collecting millions of dollars related to upcoding and fraudulently obtaining two government-guaranteed loans meant for COVID-19 pandemic relief, the U.S. Justice Department said this week. -
CMS to take next step in site-neutral pay for off-campus clinics
CMS will move forward with site-neutral pay initiatives for outpatient clinic visits for hospital services provided at off-campus facilities. -
CMS to mandate ASC employees get COVID-19 vaccine or risk losing payment
CMS plans to require ASCs, along with all other healthcare providers, to mandate COVID-19 vaccines for staff as a condition of participating in Medicare. -
Patients save an average $684 per procedure at ASCs, UnitedHealth says
Shifting routine outpatient procedures to ASCs can save commercially insured patients $684 on average per procedure, according to a Sept. 8 report from UnitedHealth Group. -
$140M judgments resolve fraud charges against chiropractor's pain clinics, businesses
Five companies, including three pain management clinics, with the same owner had a second default judgment issued against them for participating in a multimillion dollar billing fraud scheme, the U.S. Justice Department said Sept. 2. -
Cigna in the past 30 days: 7 updates
Cigna expanded its Affordable Care Act market reach to three states. -
UPMC surgeon performed, billed for illegal overlapping surgeries, whistleblower suit alleges
The U.S. Justice Department is suing UPMC, its chair of cardiothoracic surgery and University of Pittsburgh Physicians in a whistleblower suit brought by a former UPMC physician. -
California ASC sues Blue Cross NC over alleged unpaid medical bills
Tustin, Calif.-based Orange County Multispecialty Surgery Center is suing Blue Cross and Blue Shield of North Carolina for allegedly paying only a fraction of its patients' bills, the Triangle Business Journal reported Sept. 1. -
ASCs + CMS: The good, the bad and the ugly
ASCs are known as the high quality, low cost setting for surgical care, and CMS has taken notice. -
Payer problems: 7 reimbursement issues at ASCs
From COVID-19 setbacks to CMS' proposal to cut 258 procedures from the outpatient-approved list, ASC leaders are working through many challenges to secure reimbursements. -
9 procedures CMS plans to keep on office-based payable list
The proposed 2022 Hospital Outpatient Prospective Payment System and ASC Payment System, released July 19, outlined nine procedures slated to temporarily remain on CMS' office-based payable list in 2022.
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