In the intricate web of the modern healthcare industry, the term "out-of-network" has become somewhat synonymous with confusion and uncertainty for both patients and providers.

The ASC industry is constantly evolving, and one of the major players in its evolution is CMS. 

This year, eight major U.S. health systems have canceled their Medicare Advantage contracts, often citing low reimbursement rates and prior authorization hassles. 

CMS settled a record number of 104 Stark law self disclosures in 2022, totaling more than $9.2 million, according to a Sept. 18 JDSupra report from law firm McGuireWoods. 

CMS recently passed a Stark law update that will allow hospitals and healthcare providers to improve mental health services for physicians.

Serving over 1,100 surgical clients nationwide for over twenty years, nimble solutions has unique insight into the claim denial reasons for ambulatory surgery centers (ASCs). Our business intelligence and analysis team recently conducted a comprehensive study to explore the most common denial reasons for ASCs and the root cause of those denials. The study analyzed clearinghouse data from ASCs nationwide for the year-to-date period ended June 2023.

Four physicians joined Becker's to discuss the Stark law trends they are eyeing. 

The cost of common medical procedures are as much as 58 percent more expensive when performed in hospital outpatient departments compared with ASCs or physicians' offices, according to an analysis by the Blue Cross Blue Shield Association. 

Value-based care has become one of the most-used buzzwords in healthcare. But how does it apply to ASCs? 

Here are eight updates on six of the U.S.' largest payers that ASC leaders should know:

As the ASC landscape continues to evolve, so does the challenge of claim denials. As part of our commitment to providing practical solutions for our clients, nimble’s analytics team conducts on-going studies to address the most common claim denial reasons.

As part of its 2022 end-of-the-year spending package, Congress passed the NOPAIN Act, set to take effect in 2025, that will set up a separate Medicare payment for certain non-opioid pain management approaches in outpatient and ASC settings, according to a Sept. 11 report from the Baltimore Sun.

The 7th Circuit Court of Appeals remanded a district court's dismissal of an antitrust case that could have implications for noncompete agreements, according to a Sept. 8 JDSupra article from law firm Shearman & Sterling. 

The American Hospital Association, which represents 5,000 member hospitals, health systems and other healthcare organizations, has submitted a letter to CMS commenting on its proposed hospital outpatient prospective payment system and ambulatory surgical center payment system rules for calendar year 2024. 

On average, physician specialists bill $3.8 million annually to commercial payers, but some specialties, including orthopedic surgery and urology, bill well over that amount, according to data from AMN Healthcare's 2023 "Review of Physician and Advanced Practitioner Recruiting Incentives" report.

Blue Cross Blue Shield of Michigan has announced a new effort to reduce prior authorization requirements by 20 percent in order to improve healthcare quality and access while reducing administrative tasks. 

From repealing existing prior authorization requirements to adding new ones, here are four states tackling the prior authorization system this year. 

Physicians are facing rising prior authorization requirements and increasing denials, and some leaders say it is taking away their ability to make decisions. 

Three major payers have cut prior authorization requirements in August:

Here are three Stark law updates that may affect ASCs: