Tag: medical billing

Survey: 2025 business manager profile

Data and surveys

Editor's Note: This page is a companion page to the main article, "Survey: Staffing problems increase as surgical volume continues to rise."   Most OR leaders (81%) report having a business manager. Historically, fewer than half had this position (42% in 2024, 37% in 2023, and 43% in 2022). The…

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By: Cynthia Saver
September 1, 2025
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2026 ICD-10 updates bring hundreds of new codes, new complexity

Editor's Note Healthcare providers, payers, and analytics teams face sweeping ICD-10 changes this fall, with the 2026 code updates taking effect October 1, 2025, Wolters Kluwer July 14 reports. The release includes 614 new codes, 12 invalidations, 642 billability changes, 88 terminology revisions, and the creation of an entirely new…

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By: Tarsilla Moura
August 21, 2025
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Largest US healthcare fraud case reveals billions in false Medicare, Medicaid claims and vast schemes nationwide

Editor's Note The US Department of Justice (DOJ) has conducted the largest healthcare fraud takedown in US history, charging 324 individuals, including 96 licensed medical professionals, in schemes totaling more than $14.6 billion, HealthCare Business News July 8 reports. The nationwide crackdown involved 50 federal districts and 12 state attorneys…

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By: Tarsilla Moura
August 19, 2025
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Study: Medicare Advantage surgical episodes cost less, achieve similar quality as traditional Medicare

Editor's Note Medicare Advantage (MA) patients undergoing elective surgery incurred lower costs than comparable patients in traditional Medicare (TM) without higher readmission rates and with no significant difference in mortality rates, according to a study published August 1 in JAMA Health Forum. The findings suggest that MA plans reduce surgical…

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By: Matt Danford
August 6, 2025
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CMS payment overhaul could cut specialist pay

Editor's Note A “quiet transformation” in how Medicare pays doctors could reduce payments for specialty care, including rates for billing codes associated with surgery, diagnostic imaging, outpatient care, pain management, and orthopedics, Modern Healthcare July 22 reports. According to the article, The Centers for Medicare and Medicaid Services (CMS) 2026…

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By: Matt Danford
July 24, 2025
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AHA urges HHS to cut regulations that burden hospitals and staff

Editor's Note The American Hospital Association (AHA) has called on the Department of Health and Human Services (HHS) to eliminate or ease a variety of federal regulations, arguing that excessive administrative rules drive up costs, reduce patient access, and hinder innovation, Modern Healthcare reported May 13. According to the article,…

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By: Matt Danford
May 16, 2025
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Low-income patients billed despite hospital tax breaks

Editor's Note Nonprofit hospitals, which are legally required to provide free or discounted care to qualifying patients, attempt to collect hundreds of millions of dollars from low-income patients annually while receiving significant tax breaks meant to ensure affordable care, according to a May 12 article from CBS News.   As…

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By: Matt Danford
May 13, 2025
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ASCA 2025: How accounting becomes an ASC revenue generator

Editor's Note Terry A. Bohlke, MSHA, CPA, CMA, CASC, emphasized that Rocky Mountain High Surgery Center is a pseudonym “to protect the innocent,” but the numbers he presented at the 2025 Ambulatory Surgery Center Association (ASCA) Conference & Expo in Denver last week were real enough. Based on actual scenarios…

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By: Matt Danford
May 6, 2025
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CSA taps Milagro’s AI coding to accelerate revenue cycle across ASC network

Editor's Note Constitution Billing and Financial Services (CBFS), the revenue‑cycle arm of Constitution Surgery Alliance (CSA), has signed a commercial agreement with health tech startup Milagro to deploy its autonomous medical‑coding platform across CSA’s 26 partnered and managed ambulatory surgery centers (ASCs). The partnership was announced in an April 4 CSA press…

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By: Tarsilla Moura
April 9, 2025
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OR Manager Conference third place poster winner showcases impactful documentation, billing improvements of implants in orthopedic surgery

The poster presentations at the 2024 OR Manager Conference showcased exceptional perioperative initiatives, highlighting advancements and innovative practices. From streamlining documentation and optimizing billing processes to ensuring patient and staff safety in postanesthesia settings, the posters selected last year showed the ingenuity and dedication of healthcare professionals committed to excellence…

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By: Lindsay Botts
March 11, 2025
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