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Tip of the week, part 1: Steer clear of these compliance pitfalls

Managed Care Weekly Advisor, July 25, 2007

As your surgery center continues to grow and you look for ways to bring in more reimbursement, don't overlook the critical compliance problems that could come into play. With proper research and careful planning, you can avoid the following pitfalls, which are often because of common misconceptions or negligence in developing certain financial arrangements:

  1. Your ASC does not implement or execute policies and procedures: Some facilities start off as small operations with only a few physician owners and a binder of policies and procedures that they put on a shelf and never look at again. You should review physician credentialing and/or recredentialing procedures annually to ensure that your center is up to date

  2. Your ASC sells interest to utilizing physicians for less than fair market value: Ensure that your center is selling equity interests to utilizing physicians at a price that is at least equal to fair market value by obtaining a fair market value appraisal. If you aren't able or willing to spend the money on a formal appraisal, conduct an analysis to show by some objective measure that you're selling equity interests to utilizing physicians at fair market value.

  3. Your physicians try to capture ancillary revenue with pathology or anesthesia services without giving proper attention to potential compliance issues: To stay in compliance, consider a variety of business models that, with guidance, will result in an appropriate business structure. Also be sure to pay attention to state laws, such as fee-splitting laws, that could be implicated in these arrangements if not structured carefully.