Here are five moves from payers that are making waves in the ASC space:
1. Anthem Blue Cross Blue Shield Plans representing Connecticut, New York and Missouri announced that they would begin using the CMS physician work time values to identify the number of minutes reported for anesthesia services. Claims submitted above the allocated number of minutes will be denied.
2. The U.S. Justice Department filed a lawsuit against UnitedHealth Group, parent company of Optum, to block its planned $3.3 billion acquisition of home health provider Amedisys.
3. On Nov. 1, CMS released its 2025 physician payment rule, which includes a 2.83% conversion factor decrease from 2024.
4. A jury ruled that Blue Cross and Blue Shield of Louisiana shortchanged a New Orleans-based surgical center by more than $400 million after a seven-year legal fight. The insurer was accused of shortchanging the center on thousands of breast reduction surgeries.
5. At least five more health systems and hospitals have dropped Medicare Advantage plans, citing frequent reimbursement denials, escalating implant costs and increasing administrative hurdles that complicate patient care.