Ambulatory Surgery Center Billing Expert Witness
Ambulatory Surgery Center Billing Expert Witness should understand both professional fees and facility fees. ASCs use Ambulatory Procedure Codes or APCs. An Ambulatory Surgery Center Billing Expert Witness should understand that an Ambulatory Surgery Center (ASC) is a specialized designation. A true ASC is certified by the Centers for Medicare and Medicaid (CMS).
CMS approves ASCs for higher-risk procedures. Above all, CMS certified ASCs meet rigorous standards. Standards include quality, staff, records, infection control, patient assessment, and facilities. Furthermore, specific emergency equipment, documented policies, and procedures, space requirements, and anesthesia provisions are considered.
An Ambulatory Surgery Center or ASC Expert Witness must be able to decipher the correct Revenue Codes and Place of Service codes typically used in this setting. Physicians from several specialties including pain management, orthopedics, and cosmetic surgery have Ambulatory Surgical Centers.
ASCs are the only outpatient facilities that may charge facility fees for surgery. Office-based surgical centers without the ASC certification may not bill or collect facility fees. In other words, CMS certification standards for ASCs are higher than office-based standards. Therefore, TRUE ASCs may charge a facility fee. To clarify, because office-based surgery centers are not CMS certified, they don’t collect facility fees.
In conclusion, Ambulatory Surgery Center Expert Witness knowledge of facility fees, professional fees, revenue codes, place of service may be important in this context.
Specific Industry Standards for CMS Certified ASCs
§416.2 – Definitions §416.25 Basic Requirements
Specific Conditions for Coverage include:
§416.40 Compliance With State Licensure Law
§416.41 Governing Body and Management
§416.42 Surgical Services
§416.43 Quality Assessment and Performance Improvement
§416.45 Medical Staff
§416.46 Nursing Service
§416.47 Medical Records
§416.48 Pharmaceutical Services
§416.49 Laboratory and Radiologic Services
§416.50 Patient Rights
§416.51 Infection Control
§416.52 Patient Admission, Assessment, and Discharge
- Evaluate the usual customary and reasonable professional fee charges for pain management physician who performed procedures in an office-based setting
- Verify whether office-based procedures may include a facility fee
- Opinion regarding usual customary and reasonable facility fees
- Identify variances in facility fees paid according to the medical procedure