Issue link: https://beckershealthcare.uberflip.com/i/1027301
77 HEALTHCARE NEWS Colorado health system sues patient over $229K surgery bill, jury awards $766 By Ayla Ellison A jury awarded Centennial, Colo.- based Centura Health $766 in a lawsuit seeking more than $229,000 from a former patient. Here are six things to know about the law- suit: 1. In 2014, Lisa French had surgery on her back at St. Anthony North Health Campus in Westminster, Colo., part of Centura Health. Her employer had a self-funded Employee Retirement Income Security Act insurance plan, and she was told prior to surgery she would have to pay $1,336 out of pocket for the procedure. She immediately paid $1,000, according to Law.com. 2. e hospital billed Ms. French's insurance plan $303,888 for the surgery and two pre- surgical consultations. Including the patient's copays and payments from her insurance plan, the hospital was reimbursed $74,597, which an audit found was the "reasonable value of the goods and services" the hospital had provided Ms. French. 3. In 2017, Centura Health sued Ms. French in an attempt to collect the additional $229,000 it had billed for. 4. e hospital used its chargemaster bill- ing schedule to determine the amount Ms. French owed. Her lawyers argued those charges were unreasonable and that the con- tract Ms. French had with St. Anthony was ambiguous because it did not contain a price. 5. e jury agreed with the defense. Aer a six-day trial, the jury answered "no" when asked whether Ms. French's bills were rea- sonable. ey agreed that Ms. French was obligated to pay "all charges of the hospital" under the contract she had with St. Anthony. However, the jury determined that those charges were "the reasonable value of the goods and services provided," not those included in the hospital's chargemaster. 6. e hospital's lawyers said they will file post-trial motions and appeal the verdict, according to the report. n ASCs could start providing 131 more device-intensive procedures for Medicare patients if CMS approves rule: 5 things to know By Laura Dyrda C MS proposed several updates to ASC payments in the 2019 proposed payment rule, is- sued July 25. One of the key changes for ASCs would be to broaden the definition of device-intensive pro- cedures, adding around 131 proce- dures for Medicare beneficiaries in the ASC setting. Here are five things to know: 1. CMS proposed updating the defini- tion of device-intensive procedures from procedures where the device is 40 percent of the overall cost to 30 percent of the overall cost for the procedure in the hospital outpatient department. 2. The lowered threshold is expected to make it economically possible for ASCs to be able to provide 131 device-intensive procedures to Medi- care beneficiaries for the first time. "[This is] a policy change we have been advocating for over the past several years to encourage migration of these procedures into ASCs," said ASCA CEO William Prentice in a Q&A posted on the organization's website. 3. The new definition of device- intensive would increase the number of device-intensive procedures that ASCs can afford to provide to Medi- care beneficiaries from 154 to 285 procedures for 2019, if it appears in the final rule. 4. Among the newly approved cases would be several cardiac procedures. The proposed payment rule would also revise the definition of "sur- gery" for ASC payments to include "surgery-like" procedures, which would add 12 cardiac catheterization procedures to the ASC list as well. 5. For device-intensive procedures, the total cost of the device is included in the reimbursement rate for ASCs.n The jury agreed with the defense. After a six-day trial, the jury answered "no" when asked whether Ms. French's bills were reasonable.