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LEGAL UPDATE
Mathew J. Levy, JD
I
magine this: You get a
letter from an insurance
carrier asking you to
return a substantial
amount of money you'd
received for a backlog of
paid claims. You've been
FACILITY FEE FIGHT Some insurers are asking office-based suites to
return years of facility fees they were paid.
billing the carrier in the
same manner for years,
Office-Based Suites Forced
To Forfeit Facility Fees
with their approval, and
Many insurers are auditing office-based
surgery suites and asking for givebacks.
with no objection. Only
they've paid you each time
now, without warning,
they've changed their method of billing for future services, and also
revised their policy on past billings. That situation is occurring at hundreds of office-based facilities, where physicians have long been
billing separate facility fees in connection with the performance of
outpatient surgical procedures, with the explicit consent of insurers,
until now.
Devil in the details
In a typical scenario, a physician sets up a dedicated room for surgical
procedures under a separate corporate entity (owned by the physician) with a separate tax ID number to receive payments for the servA P R I L 2 013 | O U T PAT I E N T S U R G E R Y M A G A Z I N E | 3 9