7 things for ASC leaders to know for Monday — May 23, 2016

Here are seven updates:

Indiana surgery centers file lawsuits against UnitedHealthcare for overpayments
Various Indiana surgery centers are filing lawsuits against UnitedHealthcare for allegedly failing to pay for services the center's physicians rendered to patients, thereby violating state and federal law. UnitedHealthcare maintains it complied with all the appropriate state and ERISA laws and regulations, and utilized "cooperative overpayment recoveries."

Medicare loses $3.2B from DMEPOS improper medical billing
In 2015, Medicare had a 40 percent improper payment rate for improper medical billing for durable medical equipment, prosthetics, orthotics and supplies, resulting in $3.2 billion losses. The DMEPOS billing error rate is nearly three times higher than the national Medicare fee-for-service improper payment rate (12 percent).

ASCA honors Nap Gary with new outstanding services award
The Ambulatory Surgery Center Association of Alexandria, Va., recognized Nap Gary with an outstanding service award named in his honor. Last year, Mr. Gary unexpectedly passed away. He is the former ASCA and ASCA Foundation board president and served as president and COO of Regent Surgical Health.

Highmark sues federal government over $220M unpaid ACA claim
Highmark claims the government owes the payer more than $220 million in claims it is owed under the Affordable Care Act. Last fall, the Obama administration said it would not pay insurers the full amount owed under the risk-corridor program in 2014, when the program went into effect. The federal government paid insurers $362 million out of the $2.87 billion payers claimed for 2014. The government paid Highmark nearly $27 million.

Tennessee hospital closes, leaving 125 without jobs
Last week, Selmer, Tenn.-based McNary Regional Hospital closed after facility experts found substantial plumbing problems in March. The hospital decided to close permanently after considering the hospital's diminishing patient volume and the cost of repair, leaving nearly 125 employees out of work.

Culbertson Outpatient Specialty Clinic adds general surgeon team
Rushville, Ill.-based Culbertson Outpatient Specialty Clinic is adding general surgeons Michael N. Fenner, MD, Daniel M. Hallam, MD, and Abigail White, MD. The surgeons will join orthopedic outreach specialists JianJun Ma, MD, and William D. Payne, MD, at the location.

Premera Blue Cross loses millions on individual health plans; up nearly 117% from 2013
In 2015, health insurer Premera Blue Cross lost nearly $117.5 million on individual health plans. In 2014, the payer had a net loss of merely $3.3 million and had a net loss of $1 million in 2013.

More healthcare news:
Most non-group healthcare insurance enrollees satisfied with plans — 25 survey statistics
GE Healthcare, Accenture team up to help providers with medical claims management: 5 things to know
PA salary hits $94k with 10 years of experience — 14 findings from Physicians Practice's staff salary survey

Copyright © 2022 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Webinars

Featured Whitepapers

Featured Podcast