Health plans monitor certain trends in ASCs to ensure payment integrity, according to Eden Prairie, Minn.-based Optum Payment Integrity Facility Ideation Leader Robin Richards.
Five trends health plans watch for that can raise red flags:
1. Increased patient volumes
2. Decreased patient volumes
3. Procedures performed outside an ASC's normal specialty
4. New providers billing for the first time
5. Claims for the same patient at several ASCs
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