Ambulatory Surgery Centers (ASCs)

Overview
ASC Legal Experience
ASC Recent Focus Areas
Outside Resources
Articles
Speeches
Contact Us

Overview

Wachler & Associates has specific expertise counseling and representing ambulatory surgical center (ASC) clients in all legal and regulatory issues impacting ASCs. Our firm played a lead role in obtaining reimbursement from Blue Cross Blue Shield of Michigan for physician-owned ASCs ending a 20 year period where they were denied reimbursement. Our attorneys understand the unique regulatory environment pertaining to ASCs and we represent ASCs in all aspects of their legal needs. For example, Wachler & Associates regularly counsels ASC clients on matters related to:

  • Fraud and Abuse counseling including compliance with the Stark law, Anti-Kickback Statute, and ASC safe harbor
  • ASC development and joint-ventures with physicians, hospitals or health systems
  • Buying and selling of equity interests in ASCs
  • Certificates of Need and licensure issues
  • HIPAA compliance, including HIPAA privacy and breach notification issues
  • Compliance with Medicare Conditions for Coverage and Conditions of Participation
  • Compliance with Medicare and Medicaid coding and payment regulations
  • RAC, ZPICs, Medicare, Medicaid or private pay audits and appeals
  • Contractual and transactional arrangements
  • Operations, corporate governance, structural issues and compliance policies
  • Other regulatory and health care law matters

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ASC Legal Experience
  • ASC development and joint ventures with physicians, hospitals or health systems — Joint ventures between ASCs and other healthcare entities may seem straightforward, however several compliance issues may arise because the facility is being sold by physicians to a facility that may benefit from referrals by those physicians. The attorneys of Wachler & Associates have the knowledge to advise clients about joint ventures between healthcare businesses, including ASCs.
  • Purchase and Sale of ASCs and Membership Interests —Purchasing an ASC requires thorough due diligence regarding the existing entity’s compliance with regulatory requirements and Medicare claims submission requirements. It is also important for purchasers to understand what steps must be taken in order to transfer Medicare billing privileges or certificates of need. We also advise on the sale of ASCs, admission of members, and voluntary and involuntary termination in the context of compliance with the ASC safe harbors. The attorneys of Wachler & Associates have expertise in advising clients on purchasing and selling healthcare businesses including ACSs.
  • Compliance Plans — Wachler & Associates attorneys have counseled many ASCs on Medicare Conditions of Participations and Conditions for Coverage. We have experience assisting clients with regulatory compliance, HIPAA compliance, Medicare reimbursement compliance, and compliance with the Stark law and federal Anti-Kick-back Statute. In addition, our firm drafted and revised, as recently as 2014, the HIPAA Privacy and Security manuals for the Ambulatory Surgery Center Association.
  • Audits — Our firm is a nationwide leader in RAC, ZPIC, MAC, Medicare, Medicaid, and third party payer defense. We also assist our clients when appealing claim denials through all levels of the appeals process, and advising clients who have been placed on pre-payment review or payment suspension. We understand the procedural, substantive, and strategic issues involved in audit defense, and work with our clients to understand the substantive issues unique to each audit to develop an effective and practical audit defense strategy. Our strategies often include drafting position papers and written submissions specifically tailored to each audit.

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ASC Recent Focus Areas
  • “Company Model” arrangements
  • Compliance with regulatory safe harbors and sales of equity interests
  • Out-of-network business with payors
  • HIPAA violations

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Outside Resources

For the Center for Medicare and Medicaid Services’ ASC Center page, please click here.

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Articles

Our attorneys have written many articles on issues relevant to ASCs. For a complete list of Wachler & Associates articles, please click here.

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Speeches

The attorneys of Wachler & Associates often speak on issues relevant to ASCs. For a list of Wachler & Associates speaking engagements, please click here.

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Contact Us

Call us at (248) 544-0888 or send us an e-mail to schedule a meeting to discuss your concerns with ambulatory surgery center legal issues or to address your other healthcare law-related needs.

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Contact Us