On Sept. 24, CMS issued a final ruling to address "significant, anomalous and highly suspect" billing activity on the Medicare Shared Savings program to mitigate financial impacts for Accountable Care Organizations. 

Commercial and government payers alike are increasingly pushing patients to ASCs because of the cost-savings they can offer. 

Physicians could lose at least $25 billion in add-on payments for Part B drugs that could be part of the Inflation Reduction Act's program to negotiate drugs, according to a recent study by Avalere. 

ASCs are facing rising challenges with Medicare Advantage plans, including escalating implant costs, frequent reimbursement denials and increasing administrative hurdles that complicate patient care and financial stability.

As physicians and ASCs face increasing obstacles in securing reimbursements from insurance companies, many are looking to direct-pay or cash models to cut out the need for payers. 

An Alexandria, La.-based physician has been charged for his role in a $32.7 million Medicare fraud scheme involving medically unnecessary definitive urine drug testing services. 

Beginning Jan. 1, Duluth, Minn.-based Essentia Health will no longer be in-network with UnitedHealthcare and Humana Medicare Advantage plans.

A district court dismissed an oncology trade association's challenge to Stark law guidance prohibiting physicians from dispensing drugs in locations outside of their office on Aug. 30.

Here are five updates on Anthem Blue Cross Blue Shield companies, which are owned by Elevance Health, one of the largest payers in the U.S., as reported by Becker's since May 21:

ASC software solutions provider HST Pathways has partnered with revenue cycle management services company Synergen Health. 

CMS' Medicare Merit-based Incentive Payment system has new reporting options to fulfill traditional MIPS requirements.

MedHQ, a provider of advisory and administrative services for ASCs in the U.S., has acquired Trajectory Revenue Cycle Services. 

As some areas see an uptick in post-procedure claim denials from payers, ASCs may be at a loss on how to salvage payments.

From an ousted CEO to shifting financial expectations, CVS Health-backed insurer Aetna has seen an eventful August. 

Around 36% of physicians earned income from an employment source outside of their practice in 2023, the highest number in five years, according to Medical Economics' 2024 Physician Report published Aug. 14. 

Financials are important at any business — and ASCs are no exception. However, despite providing the same services, ASCs face unique challenges, such as persistent compensation disparities between ASCs and hospital outpatient departments.

St. Peter's Health, based in Helena, Mont., agreed to pay $10,844,201 to resolve allegations it violated the False Claims Act by submitting false claims to federal healthcare programs on behalf of a physician formerly employed by the system.

At the end of 2022, CMS proposed an amendment to its overpayment regulations to revise the definition of several terms, including the "identified" definition, specifying when a provider has "knowingly received or retained an overpayment."

Prior authorizations are considered obstacles by many physicians and patients alike, with 9 in 10 physicians saying in an American Medical Association survey prior authorization has a negative effect on patient outcomes.

Fifty-five percent of physicians spend at least 10 hours a week on prior authorizations, according to Medical Economics' latest "Physician Report," published Aug. 14.