• ASC suit accusing Elevance of $5.4M+ in unpaid claims revived 

    A circuit court has reinstated a suit from the Costa Mesa, Calif-based South Coast Specialty Surgery Center accusing Blue Cross of California, which does business as Anthem Blue Cross, of racking up more than $5.4 million in unpaid claims. 
  • The payer behavior physicians want changed

    Five physician leaders joined Becker's to discuss the payer behavior they'd like to see changed in 2024. 
  • 3 payer rules that took effect Jan. 1

    This year is shaping up to be a big one for major U.S. payers, with several new rules going into effect. 
  • How ASC leaders, physicians are navigating payer relations in 2024

    The ever-changing payer landscape requires leaders to be nimble in order to navigate it successfully.  
  • FTC noncompete ban: Where the proposal stands 1 year later

    In January 2023, the Federal Trade Commission proposed a rule that would ban noncompete contracts for full-time employees and independent contractors. 
  • UnitedHealthcare vs. Cigna vs. Aetna: 15 updates for 2024

    UnitedHealthcare Group, Cigna and CVS Health-backed insurer Aetna, three of the largest U.S. insurers by membership, each had an eventful 2023. 
  • The Congress members fighting CMS' 2024 pay cuts

    Nearly 200 members of Congress have co-signed a bipartisan letter urging House and Senate leaders to pass legislation addressing 2024's Medicare physician pay cuts, according to a Jan. 4 report from the American Medical Association. 
  • Cigna in 'advanced talks' to sell Medicare Advantage business

    Cigna is reportedly in "advanced talks" to sell its Medicare Advantage business to Chicago-based health insurer Health Care Service Corp., according to a Jan. 3 report from The Wall Street Journal.
  • 5 numbers on HOPD vs. ASC costs

    The reimbursement disparity between hospital outpatient departments and ASCs is frustrating leaders as costs soar. 
  • 3 provider fraud schemes in 5 weeks

    Here are three providers who have been charged or sentenced for their alleged roles in fraud schemes that Becker's has reported on since Dec. 5:
  • Sarasota Memorial, UnitedHealthcare strike outpatient Medicare Advantage agreement

    Sarasota (Fla.) Memorial Health Care System has finalized a new agreement with UnitedHealthcare allowing its urgent care, outpatient facilities and First Physicians Group healthcare providers to remain in-network with UHC's Medicare Advantage plan, according to a Dec. 29 report from the Herald-Tribune. 
  • New York governor vetoes noncompete ban

    New York Gov. Kathy Hochul has vetoed a bill that would have banned all noncompetes, The Wall Street Journal reported Dec. 23.
  • A 2024 Stark law compensation update physicians need to know

    ASCs, physician groups and hospitals can provide non-monetary compensation to physicians up to an amount of $507 for the calendar year 2024, according to a Dec. 27 Lexology report. 
  • Cigna in the headlines: 8 updates in 60 days

    Cigna, which is the fourth largest insurer in the U.S. by membership size, is considering the sale of its Medicare Advantage business.
  • Springfield Clinic, ASCs back in-network with BCBS of Illinois

    Springfield (Ill.) Clinic has reached a new agreement with Blue Cross Blue Shield of Illinois to bring members back in the network beginning Jan. 1, 2024.
  • Stark law: Where it stands and where it's headed 

    Stark law, which prohibits physicians from making referrals for many Medicare-payable services to an entity if the physician or immediate family member has a financial relationship with it, has seen a year of changes and updates to policy exceptions and statutes. 
  • New York noncompete ban sent to governor: 5 things to know

    New York lawmakers on Dec. 12 sent a bill banning noncompete agreements to Gov. Kathy Hochul for her signature, lawfirm Ogletree, Deakins, Nash, Smoak & Stewart said in a Dec. 15 article in JDSupra. 
  • The 'exploitative practice' of noncompetes: 5 key statistics 

    In its January proposal to ban noncompetes, the Federal Trade Commission calls the policy "a widespread and often exploitative practice that suppresses wages, hampers innovation and blocks entrepreneurs from starting new businesses."
  • Physicians hoping for payer negotiations in 2024

    Several major payers have faced criticism in 2023 for reimbursement and prior authorization changes within the gastroenterology space. 
  • Certificate-of-need laws: Where they stand and where they're headed

    Certificate-of-need laws, which govern where providers can build facilities, have been an obstacle to ASC growth for years, but many leaders are hopeful about the policy changes made in 2023. 

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