Two Little Rock, Ark.-based ASCs are seeking potentially millions of dollars in unpaid reimbursements from Arkansas Blue Cross and Blue Shield for procedures performed during the COVID-19 pandemic, Arkansas Business reported Dec. 11.
The ASCs — Freeway Surgery Center and Centerview Surgery Center — became temporary hospitals during the public health emergency. They allege that they should have been reimbursed for procedures as hospitals instead of at the lower rate for ASCs.
Nearly all of the commercial insurance companies agreed to increase their free schedules to reflect the hospital classification, but Arkansas Blue Cross and Blue Shield of Little Rock and HMO Partners Inc., the joint venture between Little Rock-based Baptist Health and Arkansas BCBS that does business as Health Advantage, allegedly did not agree to raise their fee schedules, according to the report.
The ASCs filed a complaint with the state's insurance department in September 2021 accusing Arkansas BCBS of violating CMS' rule that allowed them to become licensed hospitals during the public health emergency. Arkansas BCBS denied it was violating the rule.
The state insurance department hired an auditing firm to review the reimbursement rates of three major carriers to ASCs and found that "claims from one specific insurer appear to indicate that the temporary hospitals were reimbursed consistently lower than regular hospitals in both 2020 and 2021," according to the report. That insurer was Arkansas BCBS.
An attorney representing Arkansas BCBS told the news outlet that it provided Freeway with a new rate sheet at a June administrative hearing, but the ASC did not want it. The attorney said Centerview did not provide the payer with information to evaluate a new hospital rate sheet.
The hearing officer found that the Temporary Hospital Facility Act required Arkansas BCBS to offer a hospital contract to a temporary hospital facility and the act is retroactive, according to the report. The payer appealed the decision in August.
Arkansas BCBS told the news outlet it does not comment on pending litigation.