In Billing
May 4th, 2018
From Nov. 1, 2007 through Dec. 31, 2016, Banner Health billed Medicare for short-stay, inpatient procedures provided at 12 of its hospitals in Arizona and Colorado that should have been billed on a less costly outpatient basis, and inflated in reports to Medicare the number of hours for which patients received outpatient observation care, according ...
Apr 11th, 2018
Flint, Michigan’s water crisis forces screening and in-depth health assessments of 30,000 children who were exposed to lead-tainted drinking water. The water crisis occurred between April 2014-October 2015, when the Flint water supply was switched from Detroit’s treated Lake Huron water to polluted Flint River water. The 18-month exposure to lead-contaminated water may have long-term ...
In Billing
Apr 3rd, 2018
Here’s a question to consider when coding and billing for services performed as part of an accountable care organization (ACO):  who pays providers’ standing claims if the ACO dies? If the State of Utah has its way, seven payers will have to pony up $26.6 million in unpaid claims for the Arches Health Plan, which folded ...
Sep 15th, 2015
UnitedHealth Group, Inc. has agreed to pay $9.5 million to settle a putative class action accusing the company of underpaying California out-of-network ambulatory surgical centers (ASCs) in violation of the Employee Retirement Income Security Act of 1974 (ERISA), Law360 reported Sept 10. An estimated 250 ASCs may be eligible to participate in the settlement. ERISA is ...
Feb 25th, 2015
What qualifies a healthcare organization to bill facility fees? Avanguard Medical Group, Woodhaven, New York, learned the answer the hard way. The practice tried for years to collect facility fees from no-fault insurers for the use of its Brooklyn office, where office-based surgeries are performed. GEICO repeatedly denied their claims, and a court battle ensued. The NY ...