Five insights:
1. The class action alleged Horizon underpaid surgery centers for medical claims, in violation of the Employee Retirement Income Security Act.
2. In 2008, Horizon identified and nixed flawed methodology responsible for low reimbursements. However, Horizon denied the allegations set forth in the lawsuit.
3. The parties settled the dispute to avoid the cost of a trial.
4. Led by Barbara Edwards of Succasunna, N.J.-Roxbury Surgical Center, the class action may apply to any licensed ASC in New Jersey that provided out-of-network services to any Horizon member from Oct. 1, 2004, through Dec. 31, 2014.
5. Three of the class members opted out of their $4,545.61 portion of the settlement: Woodland Park, N.J.-based McBride Surgical Center, Woodland Park-based Gastroenterology Diagnostics of Northern New Jersey and Newark, N.J.-based Premier Surgical Pavilion. The final approval order and judgement did not elaborate on their reasons for opting out.
More articles on coding, billing and collections:
3 tips to build a positive team culture at ASCs + how to overcome a huge staffing challenge
ASC staffing for growth and success: 4 Qs with Hyde Park Same Day Surgicenter Administrator Melissa Rice
6 ways ASCs can collect accurate case costing data
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.