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Maryland co-op sues government over $22M+ potential fees: 5 points

Evergreen Health Cooperative, a Maryland co-op, filed a lawsuit against the federal government to avoid more than $22 million in fees, according to The Hill.

Here are five points:

1. Evergreen Health is the first co-op to file a lawsuit against the federal government, and claims the Affordable Care Act's risk adjustment program is "dangerously flawed."

2. Unless the risk corridor program undergoes significant changes, Evergreen Health cautions the program may in fact "threaten the viability of the entire Affordable Care Act."

3. The government asked the co-op to may $22 million in fees, which comprises nearly 25 percent of Evergreen Health's 2014 premiums revenue.

4. Evergreen CEO Peter Beilenson said the risk corridor program's formula favors larger, establishing companies, while serving to various state co-ops' detriment.  

5. While the ACA created 23 co-ops to promote competition, Maryland remains one of the final 10 contenders. In 2010, federal ACA grants totaling $65 million helped launch Maryland's co-op program.

More articles on coding & billing:
ASCs reduce outpatient procedure costs by $38B per year compared to HOPDs: 5 insights
How Medicare influences commercial payers & key strategies for ASCs to obtain sustainable payer rates
10 takeaways on CMS' updated Medicare managed care rules

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