Ambulatory Surgery Centers (ASC)

ambulatory surgery centerWith surgeons’ professional services being reimbursed at ever lower rates by Medicare and commercial insurance payors, it is essential to establish and maintain ambulatory surgery centers as successful profits centers for their ownership – physician and non-physician alike. Nelson Hardiman is proud to be a strategic partner for numerous ASCs that are industry leaders in attracting highly respected physicians and commanding impressive reimbursement rates, both in the in-network and the out-of-network spaces.

What sets Nelson Hardiman apart is that its attorneys not only understand the unique challenges facing ACSs, but have actively navigated its clients through every phase of an ASC’s life. Nelson Hardiman has the corporate and regulatory expertise for handling the purchase of membership interests and carefully crafting complex investment and buy-back arrangements that comply with the Medicare ASC safe harbor. Nelson Hardiman’s ability to balance outside-the-box thinking with a firm grasp of the Federal and the California anti-kickback and self-referral laws has enabled its ASC clients to have mutually-beneficial relationships with physicians, marketers and other drivers of business without having to worry about being at risk for regulatory non-compliance. Nelson Hardiman has one of the deepest benches in the region when it comes to medical staff and peer review issues, which it uses to continually keep its ASC clients up to speed with the latest developments in credentialing law, and which ensures that ASCs will be able to deal with disruptive members of their medical staff in a manner that doesn’t create exposure for the facility or its owners.

Nelson Hardiman also takes a proactive approach to reimbursement strategy and revenue cycle management for its ASC clients.  We work closely with our clients to assist them in determining whether their facilities should negotiate contracted rates or pursue out-of-network (“OON”) rates. When clients choose the former, Nelson Hardiman has not only the experience but, crucially, the industry contacts for obtaining favorable rates. Although there is increasingly more skepticism about whether the OON model will remain viable for ASCs, Nelson Hardiman firmly believes that those ASCs which can recruit top talent will also continue to attract patients with generous OON benefits. Because Nelson Hardiman attorneys have litigated high stakes cases for ASCs against numerous insurance companies and ERISA plans, and have obtained favorable settlements for the ASCs, Nelson Hardiman has the unique depth of experience to understand which reimbursement strategies ultimately will work and which ones will not. Nelson Hardiman can assist in educating and training the ASC’s billing staff on the issues that are generating the most scrutiny from the insurance industry, so that our clients are preparing for the next reimbursement audit rather than dealing with the fallout of the last one. If litigation with an unreasonable payor becomes necessary, Nelson Hardiman will strike hard and fast on behalf of its clients to make sure that they get paid.

Whether you are planning to get into the ASC business or are an existing ASC that is struggling with compliance or reimbursement issues, Nelson Hardiman can provide the strategic counseling and representation necessary to meet your particular business, regulatory or dispute resolution needs, including:

  • Business Transactions
    • Corporation and LLC formation
    • Purchase and Sale Agreements
    • Operating Agreements
    • Private Placement Memorandums
    • Commercial Lease Agreements
    • Management Agreements
    • Marketing Agreements
    • Timeshare and Co-Location Arrangements
  • Regulatory Compliance
    • Accreditation and Licensing
    • Credentialing and Privileging
    • Medical Staff Bylaws
    • Peer Review Investigations and Medical Board Reporting
    • Ant-Kickback Statute Compliance
    • Corporate Practice of Medicine
    • HIPAA
    • Reimbursement Audits and Investigations
    • Risk Assessment
    • In-house Pharmacy Arrangements
    • Financial Interest Disclosures
    • Medicare Compliance
    • Insurance Requirements on “Fee-Forgiving” and Cost-Sharing
  • Litigation
    • Appeals of Adverse Benefit Determinations
    • Overpayment Appeals
    • Managed Care and ERISA Litigation
    • Medicare Appeals
    • False Claims Act / Qui tam Whistle-blower Defense
    • Contract, Business and Employment Litigation
    • Peer Review Hearings