CMS measures, breaking news and their impact on your practice and the future of healthcare under President-elect Donald Trump captured the attention of Becker's ASC Review coding, billing and collections readers in 2016.
The following are among the most popular coding, billing and collections stories from Becker's this year.
1. California jury awards Aetna $37.4M in ASC billing fraud scheme
A California jury ruled in favor of Aetna awarding them $77.4 million in a medical billing fraud case involving ambulatory surgery centers in Northern California.
2. ASCs reduce outpatient procedure costs by $38B per year compared to HOPDs
ASCs can reduce outpatient surgery's cost by more than $38 billion dollars annually compared to hospital outpatient departments, according to a Healthcare Bluebook analysis. ASC prices are significantly lower than HOPD prices for the same procedures throughout the United States, regardless of payer.
3. Bundled payments — The market and the message are becoming consistent
Two executives with Stryker Performance Solutions wrote about the staying power and expansion of bundled payments.
4. MedPAC proposes eliminating ASC payment updates in 2017
The Medicare Payment Advisory Commission may eliminate payment updates for ambulatory surgery centers in 2017. MedPAC approved a recommendation to eliminate ASC payment updates in 2017 and made recommendations that ASCs report cost data.
5. Indiana surgery centers file lawsuits against UnitedHealthcare for overpayments
Various Indiana surgery centers filed lawsuits against UnitedHealthcare for allegedly failing to pay for services the center's physicians rendered to patients, thereby violating state and federal law.
6. What MACRA's 'go at your own pace' could mean for providers
The shift to value-based care has fueled discussion among many experts who claim providers do not have enough time or resources to succeed under a pay-for-performance system.
7. How ASCs can demonstrate value to payers
Rami Abbass, MD, is a physician involved with an endoscopy-focused ASC, shared tips on how ASCs can better demonstrate value-based care to payers.
8. Are employers excluding outpatient surgeries in insurance plans?
Despite the lower costs of outpatient surgery, many employers offer only inpatient surgery coverage, according to a report from The Washington Post.
9. What will happen to bundled payments during Donald Trump's presidency?
2017 could be a year filled with changes for the healthcare industry when President-elect Donald Trump takes office. A Medscape report examined the potential future of bundled payments under Mr. Trump.
10. UnitedHealth files million-dollar lawsuit against American Renal Associates over alleged fraudulent bills
Major insurer UnitedHealth filed a suit against the American Renal Associates in The U.S. District Court for the Southern District of Florida for allegedly submitting fraudulent bills since the beginning of 2016.