Ambulatory Surgery Centers: A critical regulatory issue
Ambulatory surgery centers are considered medical facilities that are specifically designed to give elective same-day surgeries to ease the high traffic at local hospitals. They do not offer emergency care in this type of facility because it is not considered a hospital. This type of facility means that a patient does not have to be admitted to a hospital and will go home after the procedure is finished. There are many legal issues regarding these types of facilities, and as you will read, they have to do with physician ownership, out of network waivers, and Medicare cases. It takes a lot of effort to run a surgical center and to find out what kind of legal issues can be involved with this type of center.
One of the main sources of legal debates that are prevalent in ambulatory surgery centers is when new owners are trying to “buy-out” an owner that is leaving the business. A lot of centers grapple with the understanding of their present contracts concerning buying and with the legal obligation of selling the center for retail value. When a surgery center needs to sell because of finances, the ability to find someone who will give a fair market price can be difficult. Watching and assessing which new owners that will enhance the productivity of the center. Another great debate that involves physician ownership is the newly revised coverage rules and regulations which is a necessity for the early notice of physician financial interests. These coverage conditions demand that ambulatory surgery centers contact their clients of a physician financial interest within the center in writing before the patient’s surgery. If the patient did not arrange for a primary appointment at the center before the day of the surgery, the center might not be able to get all of the necessary requirements for the surgery by telephone, mailing, or e-mailing of release forms.
The out-of-network waiver patient charges is another legal concern that is very pertinent to surgery centers. Many centers around the United States have a sizeable part of their business coming from actions for patients that are out-of-network. Insurers pay more for these one day surgeries due to the lack of restricted rate, making them appealing. The client’s monetary responsibility is higher as well. Relinquishing out-of-network fees without a proper investigation of State law could put the ambulatory center at risk. An example of this would be if a bill for a surgery for an out-of-network patient is $10,000 and the surgery center bills the insurance company for 80 percent of that fee but does not collect the co-payment from the client. The total bill should only be $8,000. When turning in the receipt to the insurance company for the entire $10,000, to the customer, providers could be in trouble for breaching the false claims act in some States. “Knowing this information; the surgery center needs to make sure their guidelines for waiving these fees, meets their State law” (Dunn, 2009).
One issue that is of great concern is the degree of Medicare reimbursement for procedures done at ambulatory surgery centers. The current Medicare charge plan is based on statistics from 1986 when the operating costs of ambulatory surgery centers were at a much higher rate then in 2012, due to today’s technology which is ever growing. Many people feel that ambulatory surgery centers are being given more money for services to patients with Medicare. “Another concern is a suggestion to add more procedures for surgeries to the list of approved surgeries by Medicare for the patients. The list has not been revised since 1995. The new and improved list would greatly add to the ambulatory surgery centers services that would be available to Medicare patients by 20%” (Baker, 2002).
In conclusion, there are quite a few legal and rigid barriers that have to be directed in order to complete a victorious ambulatory surgery center project. It is very important that the law firm that has been chosen has all the necessary knowledge in all aspects of the law in health care, along with a detailed understanding of helping the clients in the surgery center business. Apart from the key task include; assisting the developer in selecting an operating entity for the project, regulatory aspects, drafting the operating agreement or limited partnership agreement, formation of the ambulatory surgery center legal entity, and working with State regulatory agencies during licensing. References
Baker, J. J. (2002, Spring). Medicare Payment System for Ambulatory Surgical Centers. Journal of Health Care Finance, 28(1), 76-87.
Dunn, L. (2009, January). Ambulatory Surgical Center Review. Retrieved from http://www.beckerasc.com/news-analysis-asc/antikickback-legal-regulatory/top-lawyers-discuss-current-critical-legal-issues-facing-surgery-centers.html