Considering an ASC

[Extralong]

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Hey everyone,

So I've been looking into investing into an ASC and decrease the amount of hospital bureaucracy. This would be to knockout many of the B&B procedures, but mainly implanting pumps and stims.
Has anyone built/designed an ASC for their group/business? Any tips or advice that would be of benefit? Any pitfalls I should avoid? Any misconceptions that I should be aware of? Any articles that you would recommend? Anything else?

-E

 

[willabeast]

would you be a general partner or a limited partner in the ASC?

 

[Extralong]

would you be a general partner or a limited partner in the ASC?

Likely general partner

 

[BobBarker]

I looked at this the other day. The payment for 20610 is terrible

 

[bedrock]

I looked at this the other day. The payment for 20610 is terrible

Only spine procedures pay well in an ASC.

Regular major joint injections and other peripheral joint , ligament , and nerve treatments don't pay very well in an ASC.

 

[Stim4me]

Only spine procedures pay well in an ASC.

Regular major joint injections and other peripheral joint , ligament , and nerve treatments don't pay very well in an ASC.

why would anybody need to perform a major/minor joint or tendon injection in a surgical center. That's overkill, and possible insurance fraud....

 

[bedrock]

Many physicians do major joint injections with ultrasound or fluoro guidance as studies have demonstrated that blind major joint injections are off target 15% of the time.

The miss rate for injecting smaller joints without guidance is even more than 15%

And everyone accepts that hip joint injections always require guidance

I could see why some physicians do joint injections at an ASC for clinical reasons, they sure aren't making that much from them. Definitely not insurance fraud.

 

[Stim4me]

Many physicians do major joint injections with ultrasound or fluoro guidance as studies have demonstrated that blind major joint injections are off target 15% of the time.

The miss rate for injecting smaller joints without guidance is even more than 15%

And everyone accepts that hip joint injections always require guidance

I could see why some physicians do joint injections at an ASC for clinical reasons, they sure aren't making that much from them. Definitely not insurance fraud.

guidance isn't the issue, the site of service is.
if you have office fluoro or US, why would you do it in a surgical center, except for $$/site fees/monthly dividends/anesthesia fees.
if you don't have in office equipment, I guess you can justify a tendon injection in a surgical center. but that still seems overkill... and even if the professional fee is low, the surgical centers are making money.

 

[SSdoc33]

guidance isn't the issue, the site of service is.
if you have office fluoro or US, why would you do it in a surgical center, except for $$/site fees/monthly dividends/anesthesia fees.
if you don't have in office equipment, I guess you can justify a tendon injection in a surgical center. but that still seems overkill... and even if the professional fee is low, the surgical centers are making money.

clearly, stim, docs who dont have an in-office flouro are the ones we are talking about here.

i wasnt aware that it was insurance fraud to not own your own c-arm.....

 

[lobelsteve]

guidance isn't the issue, the site of service is.
if you have office fluoro or US, why would you do it in a surgical center, except for $$/site fees/monthly dividends/anesthesia fees.
if you don't have in office equipment, I guess you can justify a tendon injection in a surgical center. but that still seems overkill... and even if the professional fee is low, the surgical centers are making money.

Also, using sedation for joint injections is overkill and not in any guidelines.

 

[lonelobo]

guidance isn't the issue, the site of service is.
if you have office fluoro or US, why would you do it in a surgical center, except for $$/site fees/monthly dividends/anesthesia fees.
if you don't have in office equipment, I guess you can justify a tendon injection in a surgical center. but that still seems overkill... and even if the professional fee is low, the surgical centers are making money.

I do work comp and medicaid hip injections in ASC, pay the same professional fee as office but don't use my staff or resources

 

[Stim4me]

clearly, stim, docs who dont have an in-office flouro are the ones we are talking about here.

i wasnt aware that it was insurance fraud to not own your own c-arm.....

so it's routine to do a knee injection under fluoro/US in a surgical center? are people charging anesthesia as well? people cherry picking cases for a surgical center (ie wc, Medicaid)? sounds like borderline fraud to me and violation of stark/medicare/Medicaid rules.
And if this is the case, don't complain when they continue to slash reimbursement....

 

[SSdoc33]

so it's routine to do a knee injection under fluoro/US in a surgical center? are people charging anesthesia as well? people cherry picking cases for a surgical center (ie wc, Medicaid)? sounds like borderline fraud to me and violation of stark/medicare/Medicaid rules.
And if this is the case, don't complain when they continue to slash reimbursement....

the knee isnt the only joint that fall under 20610.

-ischial bursa
-GTB on fatties
-shoulders
-pubic sympysis
-hips


im sure i could think of more.

 

[BobBarker]

I am only going to buy one c arm. I like to do my synvisc one injections with fluoro.

 

[Stim4me]

the knee isnt the only joint that fall under 20610.

-ischial bursa
-GTB on fatties
-shoulders
-pubic sympysis
-hips


im sure i could think of more.

all overkill if you are bringing them to a surgical center. inflating costs, adding unnecessary anesthesia fees, overutilization of hospital/acs site of service costs.... thus reimbursement cuts every year (esp on 20610, you proved Medicares case by the way) .... keep it up, especially the cherry picking of cases to surgical centers based on insurances, that's as legit as it gets....

 

[Ducttape]

so it's routine to do a knee injection under fluoro/US in a surgical center? are people charging anesthesia as well? people cherry picking cases for a surgical center (ie wc, Medicaid)? sounds like borderline fraud to me and violation of stark/medicare/Medicaid rules.
And if this is the case, don't complain when they continue to slash reimbursement....

before getting all high and mighty.... many insurers will not cover 20610 when billed from an ASC. for example, 4 of my local medicaid carriers does not allow it (i just looked it up, and no im not sending them to ASC, those few that i do)

 

[lonelobo]

well I heard some people charge a level 5 to discuss a Discogram

 

[Stim4me]

before getting all high and mighty.... many insurers will not cover 20610 when billed from an ASC. for example, 4 of my local medicaid carriers does not allow it (i just looked it up, and no im not sending them to ASC, those few that i do)

good, they shouldn't. waste of resources,

well I heard some people charge a level 5 to discuss a Discogram

that's legit medical coding.... cherry picking cases for a surgical center based on revenue generation is fraud.
but you knew that loner

 

[lonelobo]

so it's routine to do a knee injection under fluoro/US in a surgical center? are people charging anesthesia as well? people cherry picking cases for a surgical center (ie wc, Medicaid)? sounds like borderline fraud to me and violation of stark/medicare/Medicaid rules.
And if this is the case, don't complain when they continue to slash reimbursement....

Nobody said anything about anesthesia charges for hip injections. Explain to me how it is cherry picking? I don't own any shares of ASC. I get paid the same to do procedure in office or ASC and there are some Wc carriers that only approve to be done in ASC. To use my own office staff and equipment is not smart financially. What are you talking about Stark violations nonsense?

 

[lonelobo]

good, they shouldn't. waste of resources,

that's legit medical coding.... cherry picking cases for a surgical center based on revenue generation is fraud.
but you knew that loner

legit ? sketchy as hell to me
This is not fraud, you have no idea what you are talking about

 

[Stim4me]

legit ? sketchy as hell to me
This is not fraud, you have no idea what you are talking about

I posted the medical billing criteria in the past with links and grids . apparently you are to ignorant to read. another angry day for you my man...
you looking to pick another fight with your trash talk?

 

[lonelobo]

I posted the medical billing criteria in the past with links and grids . apparently you are to ignorant to read. another angry day for you my man...
you looking to pick another fight with your trash talk?

what you posted in past was nonsense

please tell me more about Stark violations I am committing?

 

[BobBarker]

My only fluoro suite is in the HOPD so I do plenty of 20610 without sedation there. The hospital makes $250-350 off each one. ASC you don't get paid any extra over doing it in an office

 

[Extralong]

Wow this took a left turn really fast. Say if I wanted to transition some of my outpt fluoroscopy to an ASC, and also not do implants at the local hospital but rather in a brand new ASC, wouldn't that be reasonable?

 

[lonelobo]

Wow this took a left turn really fast. Say if I wanted to transition some of my outpt fluoroscopy to an ASC, and also not do implants at the local hospital but rather in a brand new ASC, wouldn't that be reasonable?

Should check with ASC, implants are generally something frowned upon

 

[Stim4me]

Wow this took a left turn really fast. Say if I wanted to transition some of my outpt fluoroscopy to an ASC, and also not do implants at the local hospital but rather in a brand new ASC, wouldn't that be reasonable?

probably.... for the members that have ownership in a surgical center, there are clear volume and percentage rules as defined in your ACS contracts. if you have no ownership do what you want. but if you are loner, and only taking medcaid/WC procedures to a surgical center, others to his office, and discriminating volume based on site of service, that is likely a ACS violation and stark law violation. but he is the genius on this site, so don't question him... otherwise he may send you threatening inbox messages and go after your ethnicity and religion...

 

[Extralong]

Should check with ASC, implants are generally something frowned upon

Why is that? I've actually never heard of it being frowned upon, and generally I am under the impression that many of the smaller to mid-size ASCs are with pain docs doing implants. I'm thinking of building an ASC to do these along with a few other partners with this purpose.

 

[Extralong]

probably.... for the members that have ownership in a surgical center, there are clear volume and percentage rules as defined in your ACS contracts. if you have no ownership do what you want. but if you are loner, and only taking medcaid/WC procedures to a surgical center, others to his office, and discriminating volume based on site of service, that is likely a ACS violation and stark law violation. but he is the genius on this site, so don't question him... otherwise he may send you threatening inbox messages and go after your ethnicity and religion...

I'm not try to take any sides, just wanted to get some input from members here and their thoughts. There have been very interesting discussions so far.
My understanding is that volume and speed slow down drastically from outpt to ASC due to complexity of the system.

 

[Stim4me]

I'm not try to take any sides, just wanted to get some input from members here and their thoughts. There have been very interesting discussions so far.
My understanding is that volume and speed slow down drastically from outpt to ASC due to complexity of the system.

there are a couple of issues here:

scs implants are a neutral to revenue loss in a ACS, and they benefit with trial/implants done both at the same center.
doing major joint injections in a ACS seems like overkill, and ducctape points out that most governmental carriers will not pay (good).
lonelobo mentioned that he takes wc/Medicaid to his ACS. this type of payer selection may not be legal federally or per his ACS contract....

no hate, just discussions.

 

[Extralong]

there are a couple of issues here:

scs implants are a neutral to revenue loss in a ACS, and they benefit with trial/implants done both at the same center.
doing major joint injections in a ACS seems like overkill, and ducctape points out that most governmental carriers will not pay (good).
lonelobo mentioned that he takes wc/Medicaid to his ACS. this type of payer selection may not be legal federally or per his ACS contract....

no hate, just discussions.

Thanks Stim4me. good to know. Though I am curious why lonelobo's methods may be not legal federally?

 

[Stim4me]

Thanks Stim4me. good to know. Though I am curious why lonelobo's methods may be not legal federally?

if you join a surgical center, you are obligated to bring 2/3 of your income to that center. this is a fed rule or stark rule, its universal.
you also have additional asc rules that you not discriminate where you bring procedure, you cannot bring to another acs, hospital, etc.
obviously you have margins here, and there is clinical discretion, and so forth. nobody is forcing anybody to bring SI injections to a surgical center, as its not clinically indicated most of the time. However, if you are 'intentionally' bringing your Medicaid SI injections to a ACS for financial reasons(monthly dividends, anesthesia kick backs, etc), that may violate fed rules.

 

[Ducttape]

actually, you are kind of forced to bring SI injections into an ASC, as you cannot bill for an SI injection without fluoro. it is otherwise considered a trigger point injection.

as an addendum, i am talking specifically about practices that do not have an inoffice fluoro machine.

 

[lonelobo]

Should check

Wow this took a left turn really fast. Say if I wanted to transition some of my outpt fluoroscopy to an ASC, and also not do implants at the local hospital but rather in a brand new ASC, wouldn't that be reasonable?

Should check with ASC, implants are generally something frowned upon

Why is that? I've actually never heard of it being frowned upon, and generally I am under the impression that many of the smaller to mid-size ASCs are with pain docs doing implants. I'm thinking of building an ASC to do these along with a few other partners with this purpose.

ASC usually don't make money on SCS implants

 

[BobBarker]

Yes, that is what I am interested in also ductape.

 

[lonelobo]

there are a couple of issues here:

scs implants are a neutral to revenue loss in a ACS, and they benefit with trial/implants done both at the same center.
doing major joint injections in a ACS seems like overkill, and ducctape points out that most governmental carriers will not pay (good).
lonelobo mentioned that he takes wc/Medicaid to his ACS. this type of payer selection may not be legal federally or per his ACS contract....

no hate, just discussions.

Stim there is nothing illegal about taking WC and medicaid cases to do at ASC, why would I not do it?
I have no ownership in ASC
please provide references to the fraudulent activity, instead of your personal opinions

 

[lonelobo]

Thanks Stim4me. good to know. Though I am curious why lonelobo's methods may be not legal federally?

They are not illegal, he does not no the situation though he thinks he does

 

[Stim4me]

Stim there is nothing illegal about taking WC and medicaid cases to do at ASC, why would I not do it?
I have no ownership in ASC
please provide references to the fraudulent activity, instead of your personal opinions

if you have NO ownership, it doesn't matter... proceed with your payer and site of service selection, you are fine.
If you have ownership (and making dividends on surgical cases, in addition to your profession fee) read your legalese materials...

 

[lonelobo]

if you join a surgical center, you are obligated to bring 2/3 of your income to that center. this is a fed rule or stark rule, its universal.
you also have additional asc rules that you not discriminate where you bring procedure, you cannot bring to another acs, hospital, etc.
obviously you have margins here, and there is clinical discretion, and so forth. nobody is forcing anybody to bring SI injections to a surgical center, as its not clinically indicated most of the time. However, if you are 'intentionally' bringing your Medicaid SI injections to a ACS for financial reasons(monthly dividends, anesthesia kick backs, etc), that may violate fed rules.

Wrong the number is 1/3 and Stark does not apply to ASC

 

[Stim4me]

Wrong the number is 1/3 and Stark does not apply to ASC

1/3 is correct (2/3 was my oversite,) the 1/3 volume and revenue is a part of the stark/anti kick back law. what do you mean stark/anti-kick back law doesn't apply to ASC. that makes no sense.

 

[bedrock]

Key thing here is that insurance doesn't pay for ultrasound guidance any longer, and they certainly won't give you a c-arm just for in-office procedures so they can't bitch about you talking your hip joint injections, bursa on fatties, really ancient joints, or even synvisc one injections to your ASC.

Pay is quite modest for joint injections at ASC, so no one is bilking the system to do tougher joint injections at ASC. (Provided they don't give the patient MAC for a peripheral joint injection)

 

[Stim4me]

Key thing here is that insurance doesn't pay for ultrasound guidance any longer, and they certainly won't give you a c-arm just for in-office procedures so they can't bitch about you talking your hip joint injections, bursa on fatties, really ancient joints, or even synvisc one injections to your ASC.

Pay is quite modest for joint injections at ASC, so no one is bilking the system to do tougher joint injections at ASC. (Provided they don't give the patient MAC for a peripheral joint injection)

somebody quoted 250-350$ ASC center rate, plus a professional fee. that seems like bilking to me, especially if the volume national wide is high. CMS reduced either reimbursement on pure volume...

 

[bedrock]

somebody quoted 250-350$ ASC center rate, plus a professional fee. that seems like bilking to me, especially if the volume national wide is high. CMS reduced either reimbursement on pure volume...

That was a HOPD rate.

Check the ASIPP website. The ASC reimbursement is far less for a joint injection.

 

[Stim4me]

That was a HOPD rate.

Check the ASIPP website. The ASC reimbursement is far less for a joint injection.

Sounds like We need to buy a hospital someday...

 

[lonelobo]

1/3 is correct (2/3 was my oversite,) the 1/3 volume and revenue is a part of the stark/anti kick back law. what do you mean stark/anti-kick back law doesn't apply to ASC. that makes no sense.

http://starklaw.org/investment.htm
https://www.foley.com/files/publica...54-354b954eb95d/compliance_oppenheimpatel.pdf

 

[Stim4me]

http://starklaw.org/investment.htm
https://www.foley.com/files/publica...54-354b954eb95d/compliance_oppenheimpatel.pdf

Nice to see you took the day off to read about anti kick back, safe harbor and stark laws... Now maybe you should buy some asc shares...

 

[lonelobo]

Nice to see you took the day off to read about anti kick back, safe harbor and stark laws... Now maybe you should buy some asc shares...

Took all of about 5 minutes on a google search to refresh my memory and counter your BS,
so again please tell me how I am committing insurance fraud?

 

[Stim4me]

Took all of about 5 minutes on a google search to refresh my memory and counter your BS,
so again please tell me how I am committing insurance fraud?

You're not, your not an owner genius. Buy shares in a asc and then meet all the antikick back and safe harbor rules. Plus the local asc rules... And stop being a douch.

 

[hyperalgesia]

You can do your cases wherever you want. If Medicare doesn't want us to preferentially do cases at our asc or hospital, umm...

 

[lonelobo]

You're not, your not an owner genius. Buy shares in a asc and then meet all the antikick back and safe harbor rules. Plus the local asc rules... And stop being a douch.

Maybe you should learn all the requirements of an ASC, since you clearly don't know them from previous posts.
So I point out incorrect statements you made and I am the "Douche", .......right Level 5 Discogram Boy

 

[Yo GabbaPentin]

Wow this took a left turn really fast. Say if I wanted to transition some of my outpt fluoroscopy to an ASC, and also not do implants at the local hospital but rather in a brand new ASC, wouldn't that be reasonable?

Here is a SDN pain forum fact. If your post suddenly has 30+ posts, then it has taken a hard turn left. If it makes it to 2+ pages of posts, then it has become a full on pissing match.