Becker's ASC Review

8 ASC MANAGEMENT ASC sues UnitedHealthcare for failure to cover surgery By Alan Condon A dvanced Surgery Center in Fort Lee, N.J., on April 28 filed a lawsuit against UnitedHealthcare for allegedly failing to pay for hernia-related procedures. Five details: 1. Working on behalf of a patient with an Employee Retirement and Income Security Act plan, the ASC sought preauthorization for the surgical services. 2. e hernia-related procedures were authorized individually before they were performed and the same procedure codes were properly billed aer the treatment, according to court documents. 3. e surgery center claims that as an out- of-network provider, the $117,652 bill was sent to Viant, a third-party pricing compa- ny, for repricing. e ASC said it received a $12,478.66 payment for one CPT code only; UnitedHealthcare paid $5,794.90, and $6,689.76 was applied toward the patient's coinsurance and deductible. 4. Contrary to the original authorization for all procedure codes, the repricer only paid on the main procedure code and considered all other procedure codes as lesser included charges which were not paid separately, according to the complaint. Lesser included charges is a feature for contracted providers, which the ASC said it is not. 5. United Healthcare did not respond to Becker's request for comment. n Surgical Care Affiliates rebrands to go beyond ASCs By Laura Dyrda Surgical Care Affiliates, one of the largest ASC networks in the U.S., rebranded to SCA Health. "Our new brand represents the evolution of our business — all that we are today and all that we will become. It also represents our growth into many aspects of specialty care as we support physician special- ists, care for more patients and welcome new partners into our family of businesses," states the company's website. SCA Health also updated its logo to symbolize forward growth momentum and added a tagline: "The future of specialty care." The company, which pioneered the managed service organization model aligning physicians around the transition to value-based care, now aims to move past the ASC management company label to become a leader in specialty care. In addition to supporting a network of more than 260 surgical facili- ties and 8,500 physicians, SCA Health supports physician practices through Optum Specialty Practices, providing resources to physician practices transitioning to value-based care. SCA Health also helps employers and employees navigate healthcare coverage decisions through the Surgical Management Solutions, a platform connecting users with local surgeons and facilities where they can save up to 50 percent on the cost of care. SCA Health also acquired Global 1, a value-based care platform that serves as a con- vener for the company's bundled payment contracts, in early 2021. Finally, SCA health launched the SCA Physician Development Insti- tute in 2021 to support musculoskeletal physicians and allied health professionals. The institute is an educational platform on the business side of medicine with a focus on the outpatient migration of orthope- dic procedures. n Optum ups offer 223% in bid for physician group By Laura Dyrda O ptum received clearance to buy a 30-location independent physician organization in Massachusetts after significantly increasing the amount it intends to pay for and invest in the group, according to The Boston Globe. With the approval of the Massachusetts at- torney general's office, Optum plans to pay $236 million for Auburndale, Mass.-based Atrius Health, which includes 30 practice locations and 645 physicians and primary care providers. Optum, a for-profit organization that is part of UnitedHealth Group, originally posed to pay $73 million for the physician organization, but upped the price 223 percent so Atrius could continue its charitable mission after the deal closes. Optum also plans to invest $200 million in infrastructure and provider recruitment for Atrius over a five-year period. Optum would also acquire most of Atrius' employees if the deal, which is still subject to review by the state's Supreme Judicial Court, is approved. OptumCare, Optum's physician services divi- sion, has more than 60,000 physicians in its network and plans to grow this year. n

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