Outpatient Surgery Magazine

Marking Madness - April 2013 - Subscribe

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://outpatientsurgery.uberflip.com/i/122240

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Page 38 of 157

OSM560-April_DIGITAL_Layout 1 4/5/13 2:28 PM Page 39 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

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