New Medicare Conditions for Coverage for ASCs; Increased Scrutiny of Physician- Hospital Relationships; Becker’s ASC Review E-Weekly; 16th Annual ASC Conference – Improving Profitability and Business and Legal Issues
Healthcare providers, particular physicians and hospitals, are coming under increased scrutiny. There are both increased investigations of physician-hospital and provider relationships and increased burdens being placed on surgery centers. See, for example, BNA Health Care Report dated May 20 (“Physicians Under Increased Scrutiny in Health Fraud Cases”). This issue of the Becker’s ASC Review focuses on legal and regulatory issues related to surgery centers.
1. Conditions for Coverage. A key problem with the new disclosure requirements under the Conditions for Coverage is their potential impact on “add-on”/same-day procedures. CMS, in an emergency measure driven by the efforts in part of the ASC Association, addressed this issue on May 18. There, the ASC Association reported:
“It is not acceptable for the ASC to provide the required notice for the first time to a patient on the day that the surgical procedure is scheduled to occur, unless:
the referral to the ASC for surgery is made on that same date; and the referring physician indicates, in writing, that it is medically necessary for the patient to have the surgery on the same day, and that surgery in an ASC setting is suitable for that patient.
In such situations the ASC must provide the required notice prior to obtaining the patient’s informed consent. Cases of surgery occurring on the same day it is scheduled are expected to be rare, since ASCs typically perform elective procedures. Frequent occurrence of such cases may represent noncompliance with the advance notice requirement.”
For more information, visit www.ascassociation.org/coverage.
2. Increased scrutiny of physician-hospital and physicianprovider relationships. Each week we see a Fraud and Abuse or Stark Act settlement reached with respect to kickback type of relationships or Stark Act prohibited relationships. In the past, one could review every kickback case ever settled and reach the conclusion that in each case there was a party that was a very bad actor. One of the great concerns today is that the cases and settlements often involve conduct that is so common and so technical that it is much harder to come to the conclusion that the parties engaged in the issues leading to settlements were truly bad actors rather than victims of a random lottery approach to healthcare fraud.
This lottery situation to investigation makes it more critical than ever that each surgery center adopt and stick to a true compliance effort and plan. This need not be an overly expensive effort but it does need to be a pervasive and ongoing focus of leadership of the center.
3. Becker’s ASC Review E-Weekly. The Becker’s ASC Review provides twice weekly information on surgery center business and legal issues. It also provides interesting information relating to the surgery center arena. Should you desire to be signed up for the ASC E-Weekly, either go to www. beckersasc.com or e-mail sbecker@mcguirewoods.com.
4. 16th Annual ASC Conference on Improving Profitability – Business and Legal Issues – ASC Communications/Ambulatory Surgery Foundation. Enclosed is an agenda for the ASC Communications/Ambulatory Surgery Foundation conference to be held Oct. 8-10. This is the 16th Annual Conference on Improving Profitability and Business and Legal Issues for Surgery Centers. The conference features more than 95 different speakers focusing very specifically on specialty-related issues, improving profitability issues, turnaround issues, joint venture issues, cost cutting issues, managed care issues and billing, coding and collecting issues. It should be an outstanding conference for both physician-owners, surgeons examining surgery center opportunities and for administrators and leaders of surgery centers. Should you desire more information about the conference, please email sbecker@mcguirewoods.com or call (800) 417-2035. Finally, you can register by calling (703) 836-5904.
Should you have any questions about any of these items, please contact Robert Kurtz at rob@beckersasc.com or at (781) 219-4613; jessica Cole at jessica@beckersasc.com or at (312) 505-9387, or Scott Becker at sbecker@mcguirewoods.com or at (312) 750-6016.
Very truly yours,
Scott Becker