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FEATURE


bly a physical therapist who will be involved in their treatment. They often overlook those other compo- nents of their care.” Mack says that ASCs often insist


that any ancillary providers be in net- work. “If there is a surprise medical bill, patients are going to complain to the ASC or their surgeon, which sur- gery centers want to avoid.” Despite an ASC’s efforts, however, sometimes the ancillary providers remain out of network.


Legal and PR Ramifications As the pushback against surprise bills has grown, state governments throughout the country have noticed, Schaff says. A few states, such as Cal- ifornia and New York, have passed laws addressing surprise bills. Others, such as New Jersey and Pennsylvania, have drafted legislation that has not yet passed. These laws, Schoeffel says, typi- cally focus on at least one of three areas. “They can legally limit what the patient owes. They can require cer- tain disclosures and obtaining of con- sent from patients to receive care from an out-of-network provider. Finally, the law might set up a dispute resolu- tion procedure.” If consumers receive what they perceive as a surprise bill, there is a process they can go through to explain why they believe the bill is unreasonable. These laws try to get to the fact that if you provide out-of-net- work services, you have some respon- sibility to the consumer of those ser- vices, he says. Regardless of whether your ASC is in a state with such legislation, Plavin says ASCs should take into consideration the potential market- ing ramifications of patients receiv- ing a surprise bill. “ASCs are viewed as a lower-cost environment for doing business. When patients see a bill that creates a sensation counter to this perspective, that is a public relations issue.”


Even if the surprise bill comes from an ancillary provider, the ASC and performing surgeon are more likely to receive the blame, Schoef- fel says. “As a patient, wouldn’t you expect those two providers to make sure everyone who was part of your care was consistent with your con- tracted rate?” If a patient gets a sur- prise bill, he adds, he or she will probably not recommend or refer that ASC, and “if the local media catches wind, you may have a public relations nightmare on your hands.”


Proactive Protection ASCs would be wise to check if their state has a surprise medical billing law, Mack says. “If there is a law on the books, make sure your billing pol- icies conform with the law.” For ASCs in states without such


legislation, Schaff says that might not be the case for long. “ASCs should anticipate more surprise medical bill- ing legislation. With patients being pushed in network and the growing awareness of these stories of high bills, it is only a matter of time.” Be proactive, he suggests.


Allocate


time during board meetings—at least quarterly or semiannually—to dis- cuss what is happening with respect


to out-of-network payments and reg- ulations and how the ASC should address changes. In


states expecting patients


to


receive notification of out-of-net- work services prior to the provision of services, Schoeffel says, the bur- den of disclosure is on the treating professionals. “In these situations, consumers are not expected to deter- mine whether they are in network. The ASC must make sure that disclo- sure happens.”


Whether required by law or not,


Plavin says, ASCs should make dis- closure to patients a priority. “You want to give a fair estimate of the likely cost of care and provide infor- mation ahead of time to explain any out-of-network situation.” If your ASC will provide out-of-


network services, Mack says they should be priced fairly. “If they are not appropriate, or perceived as not appropriate, that is when these bills make the news.” No one wants to be in the media for being considered a provider that overbills, so do your research to determine a fair market price for your service. “There is a bell curve for costs; you do not want to find your ASC at one end or the other,” she concludes.


ASC FOCUS APRIL 2018 |www.ascfocus.org 15


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