The issue in Children’s Hospital Central California v. Blue Cross of California was determining the reasonable value of post-stabilization emergency medical services provided by Children’s Hospital to Medi-Cal beneficiaries enrolled in Blue Cross’s Medi-Cal managed care plan.
Children’s Hospital and Blue Cross had a contract that set rates for services, but the two organizations failed to reach an agreement on a new contact in 2007, which resulted in a 10-month period with no contract in place.
During the period where there was no contract, Children’s Hospital was still required to provide emergency care to Blue Cross patients.
Blue Cross paid Children’s Hospital approximately $4.2 million for the services it provided during the no-contract period based on the Medi-Cal rates paid by the government. However, Children’s Hospital demanded its full billed charges of $10.8 million.
The Appellate Court overturned a trial court’s decision, and ordered a new trial in the case to establish damages that are based on the “reasonable value” of the services provided, not the high prices included on hospital’s “chargemaster” that almost nobody pays.
More Articles on Reimbursement Rates:
CMS Extends Medicare Payment Adjustments for Small, Rural Hospitals
10 Disruptive Forces in Healthcare
7 Methods for Reducing Avoidable Readmissions
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
