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How the payer market could change in the next 5 years
Mark Reinford predicts consolidation amongst big payers and consolidation in fee schedules in the payer market in the next five years. -
Third-party administrators can help leverage contracts, one ASC leader says
ASCs often can struggle to leverage payer contracts in comparison to larger hospitals and health systems. -
How direct contracting with ASCs can benefit employers
ASCs can often offer higher-quality care at lower rates, making it a prime location for direct contracting. -
The 258 procedures CMS plans to cut from the ASC payable list
The proposed 2022 Hospital Outpatient Prospective Payment System and ASC Payment System would remove 258 procedures from the ASC payable list if finalized later this year. -
CMS aims to reinstate the inpatient only list, boost ASC pay 2.3% in 2022
CMS issued the 2022 Hospital Outpatient Prospective Payment System and ASC Payment System proposed rule July 19, which includes some big updates for ASCs. -
CMS may stop paying for 258 procedures in ASCs
CMS proposed reversing some of the policy changes ASC executives celebrated last year. -
Implant costs vs. ASCs: How 1 management company leverages payer contracts
As higher-acuity procedures move outpatient, independent ASCs could have difficulty securing reimbursements. -
Should commercial payers launch ASC steerage programs? One administrator says yes
For Andrew Lovewell, the success of the ASC industry hinges on presurgery patient optimization and knowing which cases to take on. -
CMS proposal lowers physician pay in 2022: 4 details
CMS issued the 2022 Physician Fee Schedule proposal July 13, which will lower physician pay next year if it goes into effect without changes. -
ASC cash-pay price structure varies widely
The healthcare industry is buzzing about a July 6 article in the Wall Street Journal reporting some hospitals charge the highest rates possible for uninsured and cash-pay patients while providing discounts to insurance companies. How do surgery centers structure payments for cash-pay patients? -
CMS won't delay prior authorizations for outpatient cervical fusions
CMS forged ahead July 1 with a prior authorization requirement for cervical fusion procedures despite protest from several organizations. -
ASC profitability hinges on case-costing metrics, one administrator says
The challenge of covering implant costs and keeping up with payer regulations makes maintaining profitability tricky for many independent ASCs. -
Aetna policy change requires preapproval for cataract surgeries
Aetna began requiring that healthcare providers get preapproval for all cataract surgeries July 1. -
What the CMS surprise-billing proposal means for ASCs
CMS is taking on surprise billing with a proposed final rule released July 2. -
National Medical Billing Services expands with new facility
Chesterfield, Mo.-based National Medical Billing Services, a revenue cycle management company focused on ASCs, opened a new facility in Osage Beach, Mo. -
ASC, practice fraud whistleblowers got $107K-$1M+ in the last 2 years: 4 cases
When whistleblowers file lawsuits, they stand to receive a portion of the proceeds from a settlement or financial recovery, which can reach hundreds of thousands of dollars. -
10 commercial payer updates
Humana named a new CFO, and a Michigan health insurer launched an electronic portal to streamline the preauthorization process. -
Site-neutral payments: The Supreme Court weighs in
The American Hospital Association and other hospitals have spent the last few years disputing the CMS decision to expand its site-neutral pay policy. Now the Supreme Court has weighed in. -
Hospital noncompliance with CMS price transparency rule: What ASCs need to know
CMS' rule to make hospital pricing readily available to patients went into effect Jan. 1, and while many hospitals aren't complying, some expect ASCs to move toward price transparency. -
Blue Cross NC invests in venture to keep private practices afloat
Blue Cross and Blue Shield of North Carolina wants to make sure independent physician practices survive as the administrative burdens and costs of managing a private practice increase.
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