Issue link: https://beckershealthcare.uberflip.com/i/976338
9 ASC TURNAROUNDS Envision suing UnitedHealthcare over a bevy of payment issues — 7 insights By Eric Oliver E nvision Healthcare filed a lawsuit against UnitedHealthcare for alleg- edly unilaterally lowered contracted payments to Envision physicians and refused to add new Envision physicians to its insur- ance network, Axios reports. Prior to the lawsuit, UnitedHealth Group was reportedly interested in acquiring AmSurg, Envision's ambulatory unit, but has pulled out of talks since then. Here's what you should know. 1. Envision is suing UnitedHealthcare, saying its physicians faced pressure "to contract with United on unreasonable terms or to be out-of-network." 2. According to court documents, Envision is seeking monetary compensation for United's alleged continued breaches of the 2009 Medical Group Participation Agreement. 3. Envision claims United "willfully" disre- garded the 2009 agreement. 4. In 2009, Sheridan and UnitedHealthcare entered into a payment agreement with a provision stating that if Sheridan were acquired, the acquiring party would become subject to the 2009 agreement. In December 2016, Envision merged with AmSurg. and as a result, Sheridan became an Envision subsidiary. To comply with the contract, Sheridan noti- fied UnitedHealthcare of the Envision merg- er. Sheridan sought guidance from United on how to add new physicians to UnitedHealth- care's network in December 2016. Aer the acquisition, Envision claims United failed to provide "meaningful guidance," and as a result began a formal notification process in August 2017. Envision provided a roster of its non-participating groups to be affiliated within 30 days. United affiliated some of the providers, but not all of the providers, which defied the 2009 agreement. 5. Envision claims United unilaterally adjusted its percentage payment rate but failed to notify Envision. Envision also claims United failed to recognize Envision's multiple objections to the PPR adjustments. United allegedly moved forward in multiple instances adjusting the PPR downward, while Envision frequently objected. 6. Envision is requesting a jury trial. 7. Axios believes the lawsuit is in response to legislative and investor pressure concerning the companies' alleged surprise medical bills. e report said, "e company is attempting to reverse the narrative in court," by attributing its surprise billing to UnitedHealthcare's failure to enter Envision's providers into its network. n New Jersey pain specialist allegedly orchestrated $4.4M kickback scheme By Eric Oliver C lifton, N.J.-based Garden State Pain Manage- ment physician Todd Koppel, MD, allegedly received 790 patient referrals and billed payers approximately $4.4 million through a kick- back scheme, NJ.com reports. Here's what you should know. 1. Dr. Koppel, a pain management physician, alleg- edly paid five chiropractors to refer patients to him from 2006 to 2016. 2. Three of the chiropractors pled guilty to being involved with other kickback schemes. 3. A New Jersey grand jury in the state charged Dr. Koppel with first-degree conspiracy and money laundering, second-degree misconduct by a cor- porate official, healthcare claims fraud and other minor charges. 4. If convicted, Dr. Koppel faces up to 30 years in prison, a fine of $650,000 or both. n SSI launches analytical product for ASCs: 4 insights By Eric Oliver Revenue cycle management company SSI launched ASC Ana- lytics, an analytics product for ASCs. Here's what you should know: 1. The software will provide insights into case management, clinical operations, financial performance, cost analysis and scheduling. 2. ASC administrators will be able to identify centerwide issues as well as payer performance through the use of key clinical performance indicators provided by the platform. 3. Analytical data will be displayed on live dashboards. 4. ASC Analytics is a successor to the Medibis software plat- form. The platform will also help facilities identify growth and operational improvement opportunities. SSI Senior Product Manager Will Israel said, "We recognize that many surgery centers do not have the time or resourc- es to accurately record operational data, convey it in an easy-to-understand format and then act upon it, and that is why we have developed ASC Analytics. Now, users have the means to transform data into actionable information at their fingertips." n