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49 CODING & BILLING New York Pain Management Clinic to Pay $1.9M for Improper Billing Practices — 5 Insights By Eric Oliver S yracuse-based New York Spine & Wellness Center agreed to pay the U.S. government $1.9 million for improperly billing patients and payers for "moder- ate sedation," the Syracuse Post Standard reports. Here's what you should know: 1. The physicians violated a 2011 rule requiring physi- cians spend 16 minutes of face time with patients to bill for moderate sedation. Investigators said the centers' physicians spent less than the required time. 2. A private payer rejected claims where physician- patient face time did not last for 16 minutes. 3. U.S. Attorney Office officials said the practices stopped the improper billing and cooperated with investigators when they were contacted. 4. Around $660,000 will be returned to New York's Medicaid program. 5. The clinic has additional offices in DeWitt, Camillus and Fayetteville, all in New York. n CMS to Terminate Hull Eye Surgery and Laser Center's Medicare Benefits — 6 Insights By Eric Oliver C MS involuntarily terminated its Medicare provider agreement with Lancaster, Calif.-based Hull Eye Sur- gery and Laser Center at 12:01 a.m., Oct. 12. Here's what you should know: 1. CMS found the surgery center was "not in compliance with regulatory requirements for participation as an Ambulatory Surgery Center in the Medicare Program." 2. CMS will no longer provide payment for services to Medicare and/or Medicaid beneficiaries admitted after 12:01 a.m. Oct. 12. 3. Hull Eye Center is a full-service ophthalmology clinic. It provides laser and surgical procedures. The center has two ophthalmologists and two optometrists on staff. 4. Forrest E. Hull, MD, founded Hull Eye Center in 1959. A city park recognized Dr. Hull's significant impact on the Antelope Valley community and named a park after him in 2014. 5. Reginald Sampson, MD, now fully owns the practice after working at Hull Eye Center for four years. Dr. Sampson is the center's head ophthalmologist and surgeon. He performs 15- plus cataract surgeries weekly. 6. Hull Eye Center has its own optical shop, with an on-site laboratory. n Blue Cross Blue Shield's MA Plans to Cover Outpatient Surgery for South Carolina Residents: 4 Key Notes By Mary Rechtoris S tarting this fall, BlueCross BlueShield of South Carolina will sell Medicare Advantage plans in 23 state counties during open enroll- ment, according to Post and Courier. Here are four key notes: 1. e plans will cover outpatient surgery as well as specialist care, urgent care and prescription drug plans, among several other services. 2. Under the MA plans, enrollees are eligible for diabetic supplies, dental and vision allowance and wellness benefits from national companies. 3. Open enrollment begins Oct. 15 for 2018 MA plans and concludes Dec. 7. 4. In a news release, a BCBS executive said the company has been aiming to re-enter the MA market for two years. n The 10 Largest Health Insurance Companies by Membership By Eric Oliver Insider Monkey compiled the 10 largest U.S. health insurance companies by total enrollees. Here are the top 10 from most members to fewest members. 1. UnitedHealthcare Group, 70 million members 2. Anthem, 39.4 million members 3. Aetna, 23 million members 4. Health Care Services Corp., 15 million members 5. Cigna, 14.7 million members 6. Humana, 14.23 million members 7. Centene Corp., 11 million members 8. Kaiser Permanente, 10.7 million members 9. Highmark, 5.3 million members 10. WellCare Health Plans, 3.68 million members n

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