Agency Underpaid Outpatient Surgery Provider on 23 Claims

A Texas appellate court on Wednesday ruled that the State Office of Risk Management had been short-changing an outpatient surgical service provider by paying it less than half the amount that would qualify as “reasonable.” The court said Vista Healthcare was due more than $40,000 from SORM, plus interest. From 2003 to 2007, Vista provided outpatient surgical services to workers covered by insurance policies issued by SORM. Vista submitted 23 claims to SORM seeking reimbursement. At the time, Texas did not have any reimbursement guidelines for outpatient surgical services. ...