cannot simply say you provide patient transportation,” Kempton-Serra says. “You must document all services deliv- ered and maintain those records.” Also critical from a documenta- tion perspective: crafting a carefully worded policy describing the trans- portation service, Kempton-Serra says. “This policy should spell out the details regarding the availability of transportation and include an expla- nation of how the ASC will ensure the policy is uniformly and consistently applied. Failure to do so could put an ASC outside of the OIG’s safe harbor.” Being outside of the safe harbor does not necessarily mean an ASC is vio- lating the anti-kickback statute. How- ever, given the OIG’s history of being extremely conservative with respect to free transportation, it is important to follow the safe harbor to ensure pro- tection against civil or criminal penal- ties, she adds.

Staying within the safe harbor was a significant focus for Dutchess Ambu- latory Surgical Center when develop- ing its transportation service, Hick- man says. “We relied heavily on the expertise of our legal counsel.” The service is available only to the ASC’s ‘established patients,” which the OIG defines as a “person who has selected and initiated contact to schedule an appointment with a provider or sup- plier.” The service is not publicly mar- keted or advertised. “We also make sure transportation occurs within a 25-mile radius of the ASC and is only to and from a patient’s residence, with no additional stops,” she says Transportation for Dutchess Ambu-

latory Surgical Center is provided by a local “concierge” company, Hickman says. “The service is offered to those patients identified by our affiliated practices lacking the ability to get to the ASC for their procedures.” Another important legal element of

an ASC’s transportation service con- cerns payment, Kempton-Serra says. “The ASC must bear the full financial

We are getting to the point in medicine, with an aging population that often requires assistance to receive the surgical care they need, that all ASCs should probably be thinking about whether and how to add a transportation service.”

—Deborah Bray, RN, Tri-State Centers for Sight Surgery Center

responsibility for transportation. The service cannot be billed to patients or payers.” There are also rules govern- ing how drivers are paid. They can be paid based on mileage or time (e.g., per hour), but they cannot be paid on a per-person basis, she says.

Other Considerations While the rules governing transporta- tion services are clear in some regards, there are gray areas, Kempton-Serra says. One concerns discharge require- ments. “When you leave an ASC after you have received anesthesia, you are supposed to be accompanied by a responsible adult. The transportation safe harbor only covers established patients, not the adult required to escort a patient home.” The safe harbor lacks language stating whether free trans- portation can be provided to such an adult, and the driver is not permitted to act as the ‘responsible adult.’ “Surgery centers would be wise to consult health care counsel prior to providing trans- portation to non-patients,” she advises.

Proceed with care if you elect to establish a transportation service for your ASC, Hickman recommends. “Work with a law firm with experience in this area to help you properly set up your service. All stakeholders must be aware of the service, limitations and laws prior to initiating transportation.” Complete understanding of the pur- pose of the service is crucial to best ensure that it operates within the safe harbors of the ASC. “Also, we educate our staff about the program and the rules that govern its use,” she says. Weigh the financial implications associated with transportation before beginning the service, Bray says, there might be insurance expenses in addi- tion to the cost of the service. “ Even with these costs, offering the service remains a no-brainer for our center,” she says. “We are getting to the point in medicine, with an aging popula- tion that often requires assistance to receive the surgical care they need, that all ASCs should probably be thinking about whether and how to add a trans- portation service.”


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