Issue link: https://beckershealthcare.uberflip.com/i/1094308
33 CODING & BILLING Surgery center awarded $27K+ in workers' comp lawsuit – 6 details By Angie Stewart 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. e ASC billed Bimbo Baker- ies $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. e 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 unreason- able 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. e 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 employ- ee an award in July 2017, the court found the ASC's claim filed in September 2017 was well within the statute of limitations. e court dashed the commission's decision and awarded the surgery center the balance of the unpaid charges, in addition to interest. n Apple & Aetna build app rewarding member behavior – 7 things to know By Angie Stewart Apple and Aetna created an app to track and reward members' healthy behavior, CNBC reports. What you should know: 1. The companies have been collaborating to build the Attain app since 2016. Members can sign up to track their progress using the Apple Watch or iPhone beginning this spring. 2. Participating members will receive personalized health goals, recommendations, reminders and rewards. They will be nudged to engage in healthy behaviors such as getting their annual flu shot or taking their medication on time. 3. For members who don't already own an Apple Watch, rewards in- clude earning back the cost of the device by meeting fitness goals. 4. Members' data will be encrypted, and Apple said it won't access unique personal data. 5. Aetna will initially allow between 250,000 and 300,000 members to sign up on a first-come, first-serve basis. It eventually hopes to extend access to its 22.1 million members. 6. In early January, Apple CEO Tim Cook told CNBC he believes the company's "greatest contribution to mankind" will be related to health. 7. This is a growing trend in the insurance industry. n After losing Medicaid benefits, Ohio hospital faces 2 options, including ASC conversion By Eric Oliver A fter CMS terminated Dayton, Ohio- based The Medical Center at Elizabeth Place's Medicaid/Medicare benefits, the hospital could convert into an ASC, the Dayton Business Journal reports. What you should know: 1. MCEP CEO Beth Johnson told the Business Journal the hospital is losing up to 65 percent of its patient population from the termination. 2. MCEP did not have high enough inpatient volumes to retain its Medicare benefits. 3. A CMS official told The Business Journal MCEP can either reapply for the federal pro- grams if it can meet the benchmark or convert into an ASC. 4. Ms. Johnson said the facility would reapply for the programs before considering a status- designation change. n