University of Pittsburgh Medical Center and insurance company Highmark are at a stand-off regarding reimbursements for chemotherapy infusion claims at Arnold Palmer Cancer Center, a joint venture with UPMC and Greensburg, Pa.-based Excela Health in Greensburg, according to a report from Trib Total Media.
UPMC began billing for chemotherapy treatments that occurred at the outpatient cancer center as if they occurred at UMPC McKeesport (Pa.), an acute-care hospital about 25 miles away from the cancer center, instead of billing them under the outpatient center itself, according to the report.
According to Highmark, this style of billing results in a reimbursement that is three times as high as what UPMC was previously receiving for the outpatient chemotherapy treatments. Highmark hasn't paid a chemotherapy claim submitted at Arnold Palmer since March, according to the report, because it believes the billing switch is a ploy to increase revenues at the cancer center. It also says that it was not notified that billing had been switched.
UMPC maintains that the switch notification is well documented and that it is a common and accepted practice for hospital-based outpatient infusion centers to bill insurance companies using criteria for the supporting hospital.
Neither side has disclosed the amount of money withheld as a result of the conflict at the center, which treats approximately 130 patients each day.
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