Although the battle over the 30,000 claims is over, Highmark and UPMC are still involved in a separate dispute regarding cancer care.
Medicare regulations allow health systems to bill insurers at hospital outpatient center rates for the same care provided in system-owned physicians’ offices, a practice that sometimes leads to reimbursement being tripled. Highmark quit paying UPMC the higher rates for cancer care in April 2014.
In April of this year, UPMC warned that those with Highmark Medicare Advantage plans will be pushed out of the system’s network Jan. 1, 2016, unless Highmark increases the rates it pays to UPMC for cancer care. UPMC also demanded that Highmark drop a lawsuit against the system alleging it had overpaid UPMC on chemotherapy fees since 2010.
The cancer care battle appears to be headed to arbitration, according to the report.
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