A judge has ruled that Commonwealth Health's physician group, Commonwealth Physician Network, cannot prevent its former surgeon from working locally for Geisinger, The Times-Tribune reported Aug 21. 

Beginning Sept. 17, UnitedHealthcare Texas will begin requiring prior authorization for four medications based on new state guidelines for Texas' Medicaid program. 

Rep. Frank Pallone Jr., a Democrat from New Jersey, has announced an inquiry into the high rate of prior authorization denials by Medicaid managed care plans. 

Changes in noncompete agreements, which prohibit physicians from joining a competing practice or setting up their own within a particular distance from their previous practice for a certain period of time, are ramping up in 2023 as states amend their laws. 

Extracapsular cataract removal without endoscopic cyclophotocoagulation is the most common procedure performed at ASCs, according to recent data from Definitive Healthcare. 

As physician and administrative shortages remain high, many health facilities are pivoting to contract labor to bolster their care teams. 

In July, CMS announced its suggested 3.34 percent conversion factor decrease in its proposed Medicare physician fee schedule for 2024. This proposal, coupled with inflation and low reimbursement rates, could put an additional strain on physicians' compensation and healthcare overall.

About 43 percent of physicians receive more claim denials with Medicaid patients than other patients, according to Medscape's 2023 "Doctors Working with Medicaid" report published Aug. 9, which includes survey results from 251 practicing U.S. physicians who currently accept Medicaid patients. 

Here are five physician reimbursement statistics and trends that ASCs should know: 

Cataract removal was the most common ASC procedure by the total number of charges in 2022, according to July 26 data from Definitive Healthcare. 

In 2022, 39 percent of physicians spent one to nine hours on prior authorizations weekly, according to Medical Economics' "94th Physician Report" released Aug. 4.

The administrative costs of healthcare, including prior authorizations, are estimated to make up 20 to 34 percent of healthcare expenditures, according to an Aug. 4 report from the American Enterprise Institute, a public policy think tank.

2023 has been a tumultuous year when it comes to prior authorizations, as some payers have repealed major barriers to procedures, while others have added new rules. 

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.