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The Art of the IV Start - December 2014 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Emily Studebaker, JD REIMBURSEMENT ROUNDUP 4 4 O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | D E C E M B E R 2 0 1 4 Billing Technicality Could Cost Group of Surgeons Millions You won't believe why United Healthcare is asking these docs to repay facility fees. A group of Texas surgeons is suing to stop a giant insurer from recouping several years' worth of facility fees and withholding millions of dollars in reimbursements — all, the doctors say, because of a small billing technicality. Instead of billing United Healthcare as licensed surgical centers, as state law required, the surgeons billed as physician associations. And because of that, the giant insurer says the doctors weren't entitled to the facility fees they received. In addition to sending the surgeons overpayment demand letters for the facility fees, United has also withheld millions of dollars in payments and underpaid scores of other claims, according to court documents. Here's how the billing blunder came about. The doctors belonged to a physician association called DAC Surgical Partners. DAC entered into an exclusive-use agreement with an ambulatory surgical center whereby the surgeons paid the ASC a leasing fee for the exclusive use of an OR. For most of the physician associations in this case, that ASC was The Palladium for Surgery-Houston, according to the lawsuit the surgeons filed against United in 2011. United's stance is that the physician associations were not BILLING BLUNDER? United Healthcare is playing hardball with a group of surgeons it says failed to follow state regulations.

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