Here are five payer moves in September for ASCs to know, as reported by Becker's:
1. On Sept. 1, UnitedHealthcare rolled out its list of eligible procedures under its national prior authorization gold-card program, which went into effect Oct. 1. The list included several ASC-related codes.
2. The Office of the Inspector General for HHS alleged in audits published Sept. 25 that subsidiaries of Aetna and Humana received millions in Medicare Advantage overpayments in 2017 and 2018. The OIG estimated that HealthAssurance Pennsylvania, an Aetna subsidiary, received $4.2 million in overpayments in that period of time.
3. On Sept. 23, the Federal Trade Commission published a redacted lawsuit filed against three pharmacy benefit managers and group purchasing organizations, including Cigna's Express Scripts. Cigna is also suing the FTC over what it called an "unfair, biased, erroneous and defamatory" report on PBMs the agency published in July.
4. Exton, Pa.-based US Digestive Health signed a five-year contract with major payer Highmark Health, an independent licensee of the Blue Cross Blue Shield Association.
5. ASCs are facing a number of challenges with Medicare Advantage plans, including increasing implant costs, reimbursement denials and more administrative hurdles. In September, five health systems and hospitals announced their move to drop Medicare Advantage plans.