A New York ophthalmologist pleaded guilty to collecting millions of dollars related to upcoding and fraudulently obtaining two government-guaranteed loans meant for COVID-19 pandemic relief, the U.S. Justice Department said this week.

CMS will move forward with site-neutral pay initiatives for outpatient clinic visits for hospital services provided at off-campus facilities.

CMS plans to require ASCs, along with all other healthcare providers, to mandate COVID-19 vaccines for staff as a condition of participating in Medicare.

Shifting routine outpatient procedures to ASCs can save commercially insured patients $684 on average per procedure, according to a Sept. 8 report from UnitedHealth Group. 

Five companies, including three pain management clinics, with the same owner had a second default judgment issued against them for participating in a multimillion dollar billing fraud scheme, the U.S. Justice Department said Sept. 2.

Cigna expanded its Affordable Care Act market reach to three states. 

The U.S. Justice Department is suing UPMC, its chair of cardiothoracic surgery and University of Pittsburgh Physicians in a whistleblower suit brought by a former UPMC physician.

Tustin, Calif.-based Orange County Multispecialty Surgery Center is suing Blue Cross and Blue Shield of North Carolina for allegedly paying only a fraction of its patients' bills, the Triangle Business Journal reported Sept. 1. 

ASCs are known as the high quality, low cost setting for surgical care, and CMS has taken notice.

From COVID-19 setbacks to CMS' proposal to cut 258 procedures from the outpatient-approved list, ASC leaders are working through many challenges to secure reimbursements.  

The proposed 2022 Hospital Outpatient Prospective Payment System and ASC Payment System, released July 19, outlined nine procedures slated to temporarily remain on CMS' office-based payable list in 2022.

CMS' procedure price look-up tool allows users to compare average pay for procedures in ASCs and hospital outpatient departments.

Steve Eisentrager, president of Ohio Valley Surgical Hospital in Springfield, spoke with Becker's ASC Review on the payer policy trends to which he's paying attention.

Anthony Romeo, MD, executive vice president of the Musculoskeletal Institute of DuPage Medical Group in Downers Grove, Ill., was ready to perform orthopedic surgery on a sedated patient earlier this summer when his office received a surprising call.

Office-based labs and physician practices will see big cuts next year in dialysis vascular access services reimbursement if CMS' 2022 proposed physician fee schedule is finalized.

For Indianapolis, Ind.-based Midwest Center for Joint Replacement, a good culture fit is a priority in securing a payer contract. 

The attorney general of Arkansas is suing Conway (Ark.) Eye Care and Todd Eye Clinic over allegations that the practice defrauded Medicaid thousands of dollars.

Anthem updated its medical policy Aug. 19 to cover radiofrequency ablation, including a minimally invasive treatment of uterine fibroids.

CMS aims to refine Stark Law regulations on indirect compensation arrangements for physician referrals to services performed by immediate family members.

Payer policies and strategies are evolving as more surgeries become approved in the outpatient setting.