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.

Successful negotiations and favorable contracts with payers is the first step before surgical centers can sustainably function and grow, and navigating this process can be difficult and time-consuming.

Here are seven things physicians should know about noncompetes in 2023 so far: 

St. Louis-based physician Sonny Saggar, MD, was arrested on an indictment accusing him of healthcare fraud, the U.S. Justice Department said July 27. 

Prior authorization has continued to be a thorn in the sides of physicians nationwide. 

On Sept. 1, UnitedHealthcare will begin a two-phased approach to eliminate prior authorization requirements for several procedure codes. 

Anesthesia costs are skyrocketing, and some ASCs are worried about sustainability of these issues if payer reimbursements do not adjust. 

Certificate-of-need laws vary by state and consequently can have a huge impact on ASC development in each region.

Some leaders believe payers will be forced to increase ASC reimbursements as they become more lucrative amid healthcare's shift to value-based care. 

As a low-cost site of service, ASCs could benefit as value-based care's influence in healthcare heightens. 

July has been a busy month for CMS, from facing Congressional pressure on a prior authorization overhaul to the addition of dental surgical codes in its prospective payment system proposal for 2024. Here is how four changes floated in the last 30 days will impact ASCs: 

Here are four major insurance companies, including UnitedHealthcare and Aetna, facing lawsuits in the last 60 days: 

Noncompete clauses affect between 37 and 45 percent of physicians, according to a report from the American Medical Association, and often can limit career growth and restrict physicians' ability to provide care in economically or socially marginalized communities. 

Healthcare and insurance company Cigna is facing a lawsuit alleging that it systematically rejects patient claims using an algorithm system it put in place to automate the process, according to a July 24 report from Forbes.

Suburban Chicago physician John Greager, MD, and his ASC will pay more than $757,000 to settle allegations he submitted fraudulent claims to Medicare and the Federal Employees Health Benefits Program.  

A bipartisan Congressional majority is putting pressure on CMS to finalize a federal regulation that would overhaul prior authorization within Medicare Advantage, according to a July 24 report from the American Medical Association.

Here are four Stark law changes Becker's has reported on since Feb. 15:

Josh Troast, director of ambulatory surgical services for Muskegon (Mich.) Surgical Associates, joined Becker's to discuss what ASCs need to thrive in the next five years. 

Health Care Service Corp., a health plan operator for 18 million members across Illinois, Montana, New Mexico, Oklahoma and Texas, is integrating artificial intelligence and augmented intelligence to reform its prior authorization process. 

CMS pitched a 2.8 percent average rate increase for ASCs next year, and many leaders feel the move isn't enough to offset increasing costs.