Case Law

What is an Ambulatory Surgery Center? It is a medical facility which is designed in order for people to be able to have elective same-day surgeries rather than having to deal with the amount of traffic which most hospitals have. Since it is not a hospital, it does not have emergency care. A facility such as this would mean that a patient does not have to stay overnight as they would if admitted to a hospital. The patient is able to go home once the procedure is complete.

This type of organization does have a lot of legal issues; and some of those legal issues will be read about in this paper; issues that deal with physician ownership, Medicare cases, and even out of network waivers. A surgical center takes a lot of endeavor in running a surgical center as well as learning what type of legal issues might be included when running this type of a center. Legal Concerns A main concern that is a prevalent legal debate in an ambulatory surgery center is when an owner is getting out of the business and a new owner is going to “buy-out” that owner.

Many centers struggle with their current contracts regarding buying as well as the legal obligation of selling the center for the retail value. If the surgery center was being sold due to finances, it would be more difficult to find a buyer who will give the fair market price. There is a need to watch and assess which new owner can/will increase the productivity of the center. One more debate which involves a physician ownership is that there are new revised coverage rules and regulations that are required for an early notice of physician financial interests.

The coverage rules require that ambulatory surgery centers get in touch with the clients of a physician financial interest in the center before the patients surgery in writing. The patient needs to arrange an initial appointment in the center before the surgery date; because if the patient is not seen before the day of surgery, it is possible that the center was not able to acquire the needed release of forms by email, mail or by phone. Out-of-Network Waiver One more legal concern that is relevant to a surgery center is the out-of network waiver patient charges.

Many surgical centers in the U. S. will have a substantial number of their patients coming from activities for patients who are out-of-network. There is no restricted rate on a one day surgery so insurers pay more and this makes them more appealing. The patient’s monetary responsibility will also be higher. Surrendering the out-of-network fees without the proper investigation of State law may put the ambulatory center at risk. For example, if the bill for the out-of-network surgery patient were $10,000. 00 and the center charged the insurance company for 80% of that $10,000.

00 and does not get the co-payment from the patient then the total bill should only be $8,000. 00. When they turn in the total receipt to the insurance company for the full amount of $10,000. 00, to the customer providers may be in deep trouble because of violating 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). Medicare Reimbursement Another issue of great concern is the amount of Medicare reimbursement for the one day procedures that are done at ambulatory surgery centers.

The Medicare charge plan which is currently based on statistics of 1986; and that was at a time that the operating costs of the ambulatory surgery center was at a greater rate than now in 2012, because today’s technology is constantly developing. A lot of people believe that ambulatory surgery centers get more money from Medicare patient’s services. “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) Conclusion In conclusion, there are many legal and rigid barriers that must be instructed so as to conclude a successful ambulatory surgery center. The law firm that was chosen should have all the essential information in every aspect of all health care law as well as a complete understanding of how to help any client in the surgery center business. Aside from the job of aiding the buyer the selection of an operating person for the center,

drafting the operating agreement or a limited partnership agreement, regulatory aspects the configuration of the ambulatory surgery centers legal person, as well as 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