A federal judge in Florida has dismissed a whistleblower lawsuit accusing a medical practice of inflating Medicare reimbursements, citing constitutional concerns over the False Claims Act's qui tam provisions, law.com reported Oct. 4. 

Denials of claims are increasing, along with the administrative burden of managing them, according to Experian Health's "2024 State of Claims" survey. 

Migrating procedures to the ASC setting has the potential to save patients, payers and healthcare money.

Stark law has evolved into a complex framework that continues to challenge physicians, and as regulatory changes and enforcement actions escalate, leaders are grappling with how best to comply with these laws. 

Nearly 75% of providers report an increase in claim denials, a 31% jump since 2022, according to the Experian Health's "2024 State of Claims" survey. 

The future of Stark law is "clouded by uncertainty" after a district court ruled that a false claims lawsuit filed against Thomas Health System cannot be resolved without parties' briefs on the U.S. Supreme Court's recent overturning of the Chevron deference, according to a September blog post from law firm Hooper Lundy. 

The U.S. House Sept. 23 has unanimously passed a bill allowing mail delivery of prescription drugs to Medicare patients.

On Sept. 24, CMS issued a final ruling to address "significant, anomalous and highly suspect" billing activity on the Medicare Shared Savings program to mitigate financial impacts for Accountable Care Organizations. 

Commercial and government payers alike are increasingly pushing patients to ASCs because of the cost-savings they can offer. 

Physicians could lose at least $25 billion in add-on payments for Part B drugs that could be part of the Inflation Reduction Act's program to negotiate drugs, according to a recent study by Avalere. 

ASCs are facing rising challenges with Medicare Advantage plans, including escalating implant costs, frequent reimbursement denials and increasing administrative hurdles that complicate patient care and financial stability.

As physicians and ASCs face increasing obstacles in securing reimbursements from insurance companies, many are looking to direct-pay or cash models to cut out the need for payers. 

An Alexandria, La.-based physician has been charged for his role in a $32.7 million Medicare fraud scheme involving medically unnecessary definitive urine drug testing services. 

Beginning Jan. 1, Duluth, Minn.-based Essentia Health will no longer be in-network with UnitedHealthcare and Humana Medicare Advantage plans.

A district court dismissed an oncology trade association's challenge to Stark law guidance prohibiting physicians from dispensing drugs in locations outside of their office on Aug. 30.

Here are five updates on Anthem Blue Cross Blue Shield companies, which are owned by Elevance Health, one of the largest payers in the U.S., as reported by Becker's since May 21:

ASC software solutions provider HST Pathways has partnered with revenue cycle management services company Synergen Health. 

CMS' Medicare Merit-based Incentive Payment system has new reporting options to fulfill traditional MIPS requirements.

MedHQ, a provider of advisory and administrative services for ASCs in the U.S., has acquired Trajectory Revenue Cycle Services. 

As some areas see an uptick in post-procedure claim denials from payers, ASCs may be at a loss on how to salvage payments.