Appeals Court Affirms Decision Against Arizona ASCs Claiming Workers’ Comp Carrier Violated Law Through Use of Outside Vendor

The Arizona Court of Appeals has affirmed a county superior court decision against two surgery centers that argued the state’s leading workers’ compensation insurer broke the law by using an outside vendor to determine what the ASCs should receive for workers’ compensation payment, according to an Insurance Journal report.

Advertisement

The Arizona ASCs, Canyon Ambulatory Surgery Center in Phoenix and El Dorado Surgery Center (now known as Tucson Surgery Center), had sued in hopes of receiving 100 percent of billed charges from SCF Arizona, the workers’ compensation carrier, after Qmedtrix, the outside vendor, recommended less.

The appeal court upheld a 2008 county superior court decision that the practice by SCF Arizona to use an outside vendor to receive recommendations for what to pay when reimbursement is not previously determined by contract or fee schedule is a standard, acceptable practice and the amount recommended by Qmedtrix and paid to the ASCs was “reasonable,” according to the report.

The ASCs received $3.59 million and were seeking an additional $4.69 million from SCF Arizona.

Read the Insurance Journal report about Arizona ASC workers’ compensation.

Advertisement

Next Up in ASC Coding, Billing & Collections

Advertisement

Comments are closed.