ASC disputes payer’s conclusion that spine cases should have been in the hospital

The Center for Pain Management remains out of network with Blue Cross and Blue Shield of Minnesota after the payer terminated its contract over safety concerns in October.

Advertisement

The practice, which includes multiple locations and an ASC in Alexandria, Minn., disputed Blue Cross’ claims and wants to resolve the issue, according to the St. Cloud Times.

Blue Cross’ review examined 20 elderly patients, 19 with spine pain, who the payer said should have undergone their treatments in the hospital. The patients received transforaminal epidural steroid injections or radiofrequency ablation without complications. Blue Cross also accused the physicians of unnecessarily inflating the cost of care with spinal injections ahead of treatment.

Mike Hatch, attorney for the Center for Pain Management, told the St. Cloud Times the practice used mild anesthesia because transforaminal epidural steroid injections and radiofrequency ablations include painful needle sticks.

Blue Cross reported the Center for Pain Management to the Minnesota Department of Commerce and FBI, but neither agency commented on the review.

At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.

Register to Attend Webinar

160 ambulatory leaders just ranked the EHR as the single system most overdue for AI reinvention

Tuesday, August 11
12:00 PM - 1:00 PM CDT

Presenter: Gautam Shah, MBA, FACHDM, NextGen Healthcare

Advertisement

Next Up in ASC Coding, Billing & Collections

Advertisement

Comments are closed.