Amblitel News & Events

NEWS & EVENTS

Archive for November, 2012

Four Colorado ASCs File Antitrust Lawsuit

Added 11.28.12

Four Colorado ambulatory surgery centers have filed an antitrust lawsuit (PDF) in U.S. District Court in Denver against HCA, HCA-HealthOne, Centura Health, the Colorado Ambulatory Surgery Center Association and Kaiser Foundation Health Plan of Colorado charging them with anti-competitive activities and restraint of trade agreements. Read more at ModernHealthcare.com: more...

NJAASC Asks New Jersey Department of Banking and Insurance for a Stay

Added 11.28.12

The New Jersey Department of Banking and Insurance adopted new PIP regulations on Nov. 15, 2012, the main parts of which and the fee schedule will go into effect 60 days hence. The regulations are located here. First introduced in 2011, they have prompted a firestorm of criticism from the healthcare community, says Jeff Shanton, administrator of Journal Square Surgical Center. "The Department has seen fit to adopt in its entirety (rules and fee schedule 2011 CMS, which we feel is dead wrong," he says. "Use of the Medicare fee schedule as methodology is incorrect, as the statute (NJSA 39:6) clearly states: shall incorporate reasonable and prevailing fees of 75 percent of practitioners within the region." Read the rest of this article... more...

Outpatient Urological Surgery Costs Significantly Less When Performed In Physician Offices & ASCs

Added 11.28.12

More and more outpatient surgical procedures are being done at nonhospital-based facilities such as freestanding ambulatory surgical centers and physician offices, instead of at hospital-based outpatient departments. A new study comparing the cost to Medicare of 22 urological surgical procedures performed in each setting has found that ambulatory surgery centers and physician offices are less costly than hospitals. The results are published in the December issue of The Journal of Urology. Read the rest of this article from Science Codex.com at: more...

Organized Medicine Moves to Block End Run on Prompt Pay for Physicians

Added 11.28.12

Insurance companies are trying to invalidate state laws requiring prompt payment of physician claims. They cannot be allowed to do that. Physicians rely on timely claims processing for the smooth operation of their practices. When legitimate, clean claims languish in the administrative netherworlds of insurance companies without forthcoming payments, practices struggling to keep up their thin margins can find themselves in serious financial trouble. Physician advocates have worked diligently to hold insurers’ feet to the fire on this issue, pursuing action at statehouses and in the courts when needed. Every state has some law on the books to penalize health insurers that fail to pay claims promptly. Unfortunately, one of the stronger doctor protection laws for which organized medicine worked the hardest is... more...

An ASC With 72-Hour Post-op Stays?

Added 11.28.12

Missouri turf battles centers on how long patients can stay in an ASC following surgery. Surgery center developers and hospital advocates in the St. Louis suburbs are sparring over the legality of patients recovering in ASCs beyond 24 hours. Orthopod George Paletta, MD, wants to build an orthopedic surgery center in Chesterfield, Mo., where 6 or 7 patients would be able to recover for up to 72 hours following surgery. Extended patient stays create the possibility of the surgery center competing for more complex and high-paying orthopedic cases from local hospitals. But a few miles down the road in Creve Coeur, a similar project was squelched by local officials after area hospital groups voiced their objections. Read the rest of this article from Outpatient... more...

Cigna Subsidiary Suing N.J. Surgical Center for $6.6M for Claims of Waiving Patient Costs

Added 11.19.12

Here's and article from North Jersey.com that should be watched for the implications it can have for New Jersey ASC's. An insurance company has sued an ambulatory care center for waiving the copays and deductibles patients must pay when they go to an out-of-network facility. The insurer, a subsidiary of Cigna, says that Roseland Ambulatory Surgery Center in Essex County must repay more than $6.6 million — the entire amount it received for 1,400 claims for which the patients were not billed their share. A spokesman for Roseland Ambulatory Surgery Center said the insurer was using the lawsuit as a negotiating strategy.  Roseland's response to the lawsuit is due at U.S. District Court in Newark today.  The case was filed "during the middle of... more...

Medicare Payment Cuts Loom for ASCs; Economists Warn Forestalling Could Have Dire Consequences

Added 11.19.12

Congress and President Obama have returned to Washington to determine the outcome of several pressing issues: whether to extend the expiring tax cuts from the Bush administration, whether to stall a huge cut in physician payments under Medicare and how to enact $1.2 trillion in previously approved across-the-board spending cuts scheduled to start in January 2013, according to an ASCA report. More at Becker's ASC Review: more...

10 Characteristics That Increase Surgery Center Risk

Added 11.19.12

As merger and acquisition trends continue to ramp up in the ASC industry, many surgery center owners are asking themselves the critical question: "What is my ASC worth?"  Surgery center value is impacted by a laundry list of factors, including physician ownership, managed care contracts, market characteristics, legal structures and physical plant.  Here are 10 characteristics that increase surgery center risk, according to the survey. 1. High level of ownership by physicians in competing centers. 2. Significant number of active physicians nearing retirement age. 3. High reliance on out-of-network payors. 4. High concentration of revenue from a single payor. 5. Aging facility/poor layout of facility. 6. Facility location (patient/physician convenience). 7. Expected growth in future periods. 8. Rate of growth of prior two to three year period. 9. Lack... more...

4 Ways Physician Involvement Will Improve ICD-10 Implementation

Added 11.19.12

Here are several ways to improve clinical documentation improvement and limit the burden created by ICD-10 implementation, including getting physicians more involved, according to PhysBiz Tech. 1. Minimize memorization. 2. Avoid medical coder queries. 3. Encourage physicians to teach themselves. 4. Choose technology wisely. Read the rest of this article from Becker's ASC Review at: more...

ASC InSight Adds Powerful New Features

Added 11.19.12

ASC Insight, the Ambulatory Surgery Center industry’s most comprehensive Business Intelligence solution, has recently rolled out new functionality that widens the gap between it and its competitors. Insight Dashboard The ASC InSight Dashboard starts with a heads-up display that allows users to monitor their most important Key Performance Indicators at a glance and adds the ability to drill through on those Measures to analyze problem areas by Dimensions including Specialty, Physician, Financial Class, and Payer. The user can select Center and Timeframe (ie: MTD, QTD, YTD, Last Month, Last 12 Months) and can then view gauges and indicators with green/yellow/red indication of performance. The user can click on a gauge or indicator and drill to a chart and grid showing the breakout... more...