Channel Sponsor - Coding/Billing/Collections

Sponsored by National Medical Billing Services | info@nationalASCbilling.com | (636) 273-6711

Illinois co-op sues government over $72.8 risk-corridor payments: 5 key points

Last week, Illinois' Land of Lincoln Health filed a lawsuit against the federal government over $72.8 million unpaid claims the payer alleges it is owed under the risk-corridor program, according to Insurance Business America.

Here are five key points:

1. In 2015, the Illinois co-op lost $90 million, and lost $7 million in the first quarter of 2016.

2. Land of Lincoln Health plans to withdraw from the group market next year, but plans to continuing offering plans in the individual market.

3. Earlier this month, Evergreen Health Cooperative, a Maryland co-op, filed a lawsuit against the federal government to avoid more than $22 million in fees. Evergreen Health claimed the Affordable Care Act's risk adjustment program is "dangerously flawed."

4. Last year, payers requested the government pay them $2.87 billion for participation in the risk-corridor program. In October 2015, the government said it would pay less than 13 cents on the dollar of the amount payers requested.

5. Land of Lincoln received only $550,000 in 2014, substantially less than the $4.5 million the payer requested.

More articles on coding & billing:
Coding productivity, accuracy decrease with start of ICD-10: 8 observations
Payers & telehealth companies improving their working relationship — 5 insights
Aetna-Humana's road to regulatory approval is proving much smoother than Anthem-Cigna's — Here's why

© Copyright ASC COMMUNICATIONS 2019. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Top 40 Articles from the Past 6 Months