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.

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Page 42 of 157

OSM560-April_DIGITAL_Layout 1 4/5/13 2:28 PM Page 43 LEGAL UPDATE In our view, as health law attorneys, an insurance carrier that has explicitly agreed to the billing of office-based surgery facility fees and that has continually paid such fees without objection, where full disclosure of the accreditation status of the facility has been made, has no legal grounds to seek repayment of claims already paid to providers who relied upon this agreement in submitting claims for facility fees. However, it remains a weighty decision for every physician who receives such a notification letter from an insurer — challenge the demand, or simply seek to negotiate some form of reduced amount? Considering the amounts being demanded, this decision may be a foregone conclusion. OSM Mr. Levy (mlevy@drlaw.com) is a partner in the Westbury, N.Y., office of Kern Augustine Conroy & Schoppmann, a law firm devoted to the representation of healthcare professionals. A 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 | 4 3

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