Will the Government Take a Bigger Role in ASC Billing Practices?
Elyse Hartman owns an educational website for current and aspiring medical coders, which can be found at http://www.medicalcodingtrainingcertification.com.
A recent death at a Maryland plastic surgery center has lawmakers there looking to take more control of ambulatory surgery centers, in an effort to regulate operations. What effects this may have on coding and billing practices remains under wraps right now, but as with anything the government gets its hands into, you can expect change, and sometimes not for the better. The problems with having the government step in and take more control over ASCs are multiple and should be worrisome to anyone who recognizes the issues that arise with being overseen by people who have limited knowledge about an industry.
Death at a local ASC
The incident, which occurred at a plastic surgery center in Baltimore, has lawmakers seeking permission to oversee all plastic surgery centers. The woman, who hailed from Lochearn, died after a botched liposuction operation. Secretary Joshua Sharfstein confirmed that the state of Maryland's health department had already been debating whether or not to seek changes to the legal definition of "free-standing surgery centers" to bring them in line with medical regulations concerning risk, rather than in line with the billing practices of insurance agencies.
Maryland is unique in the fact that state inspections can only occur if ASCs meet a set of guidelines on how their billing practices run with insurance companies. But with the death of the Lochearn woman, as well as two other patients at the same Monarch Medspa coming down with aggressive infections, lawmakers are now taking a closer look at the billing practices of ASCs.
Mr. Sharfstein feels there is something very disturbing about the regulations being based on billing rather than being based on medical risks. He finds it compelling and worth looking into as, while the physicians and nurses must be board-certified, the facilities don't always stand up to medical regulations. That's because the federal government and insurance companies have regulated the standards of infection and safety. The problem seems to arise from ASCs that deal mostly with cash-paying patients.
ASCs that have individual physicians bill their patients directly fall outside Maryland's definition of an ASC. The state defines ASCs as a place where outpatient procedures are performed, but where billing comes from the center as a whole, not the physicians themselves. And while laws were passed in 2010 to address plastic surgeon error, the ASCs themselves were left alone.
Tighter restrictions to follow?
Some worry this could lead to a slippery slope of legislations against ASCs that could eventually impact billing and coding practices. With tighter regulations, some insurance companies could become reluctant to give the green light for certain procedures -- or worse, not wish to deal with ASCs at all, instead opting for hospitals to perform the procedures. This is because many people feel that once the government starts looking into a certain area, it doesn't stop until it has taken the area over.
For instance, requirements by the government to restrict certain medications could prove costly to ASCs should they have to purchase the medications from companies that have contracts with the government. Further, tying up patient health in bureaucratic red tape could place patients and physicians in a sort of limbo as the legislators try to figure things out. And while it's uncertain what these changes may bring about, it certainly is something to keep an eye on, especially with the changing landscape under President Obama's healthcare reform.
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