Thirteen percent of denied prior authorization requests made by Medicare Advantage organizations met Medicare coverage rules, according to a review conducted by the HHS Office of Inspector General released in April. 

Insurers are sending mixed messages to ASCs and independent physicians. On one hand, they want surgery centers and physicians to stay independent to keep costs low; on the other, they are increasing prior authorizations and denial policies that make it harder to get surgeries approved.

Donald Woo Lee, MD, was sentenced to 93 months in prison and ordered to pay more than $4.5 million for his role in a Medicare fraud scheme, the U.S. Justice Department said April 28.

Value-based care is gaining traction in the ASC industry as CMS and payers see opportunities in bundled payments over traditional fee-for-service models. 

Here are five updates from CMS in the last two weeks:

Here are more than 50 stats about ASC operating expenses from VMG Health's 2022 "Multi-Specialty ASC Benchmarking Study:"

ASC billing services provider Surgical Notes is promoting several senior managers after the company's client base more than tripled over the last 12 months.

Mnet Health, a revenue cycle management and technology provider, and One Medical Passport, a Mnet company have rebranded as One Mnet Health.

Here are 39 stats about ASC revenue from VMG Health's 2022 "Multi-Specialty ASC Benchmarking Study:"

Anthem has captured the attention of multiple hospitals and health systems across the U.S. as allegations of underpayment and inappropriate denials accumulate.

Healthcare e-commerce startup Fair Market Health was dreamed up when a group of physicians from Wichita, Kan., decided they wanted to replicate the patient and provider benefits of a cash-based Oklahoma City ASC, Wichita Business Journal reported April 13.

CMS recently answered questions about requirements of the No Surprises Act and about giving good faith estimates to uninsured and self-pay patients.

Physician groups and surgery centers are increasingly cutting insurers from the care delivery equation and contracting directly with employers and cash-paying patients.

Much like the spine itself, medical coding constitutes the backbone of your revenue cycle. As more spinal procedures are performed on an outpatient basis in ambulatory surgery centers, minimizing surgical coding compliance errors is critical to sustainable revenue capture.

The Medicare Payment Advisory Commission proposed aligning Medicare pay rates for ASCs, hospital outpatient departments and physician offices during policy meetings April 7 and 8.

Gastroenterology comprises 41 percent of cases for ASCs in the Atlantic, the highest of any region, while orthopedics represents 20 percent of cases for surgery centers in the Mountain area, according to VMG Health's "Multi-Specialty ASC Benchmarking Study" for 2022.

ASCs in the South receive the highest percentage of their collections from commercial payers, followed by surgery centers in the Midwest, according to VMG Health's "Multi-Specialty ASC Benchmarking Study" for 2022.

Insurers and health systems across the U.S. have been at odds during the most recent cycle of contract negotiations, and terminated contracts are affecting thousands of patients.

Aetna, a CVS Health company, insurers about 39 million people. 

Kaiser Permanente Health Plans was the largest payer by total incurred claims in 2020, according to data firm Definitive Healthcare.