Surgery center awarded $27K+ in workers' comp lawsuit — 6 details

Written by Angie Stewart | January 31, 2019 | Print  |

A Virginia appeals court ruled Roanoke (Va.) Ambulatory Surgery Center's claim seeking full compensation for two surgeries wasn't time-barred and awarded the surgery center the full balance for the procedures, Business Insurance reports.

What you should know:

1. Roanoke Ambulatory Surgical Center performed two shoulder cuff repairs on a patient who injured his right shoulder while working at Bimbo Bakeries in Horsham Township, Pa. The ASC billed Bimbo Bakeries $23,122 for one procedure performed April 29, 2015, and $12,101 for the second procedure performed Sept. 18, 2015.

2. Bimbo Bakeries paid the center $4,863 for the first bill and $3,078.81 for the second, with documents stating the payment was fair and reasonable based on geographical analysis.

3. In September 2017, the ASC filed a claim with the Virginia Workers Compensation Commission requesting full compensation. The deputy commissioner awarded the ASC the full balance of $27,281.09, finding the ASC's claim wasn't time-barred and that Bimbo Bakeries didn't provide sufficient evidence to show the charges were unreasonable and unnecessary.

4. Bimbo Bakeries sought a review, in which the commission reversed the surgery center's award, but the surgery center appealed the decision.

5. The surgery center said it filed its claim within the time restrictions delineated in a separate statute of limitations, which says "the claim must be filed one year from the date on which the final medical award to the injured claimant was issued."

6. Since the commission granted the employee an award in July 2017, the court found the ASC's claim filed in September 2017 was well within the statute of limitations. The court dashed the commission's decision and awarded the surgery center the balance of the unpaid charges, in addition to interest.

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

© Copyright ASC COMMUNICATIONS 2020. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here.