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Fall 2012


The Company Model




The most important event of the year to date, for anesthesiologists and for everyone involved in health care in any way, was of course the Supreme Court decision upholding the Affordable Care Act. Also of great consequence to the anesthesia community was the “company model” Advisory Opinion issued by the Office of the Inspector General on June 1, 2012. Mark Weiss, Esq., whose name is familiar to many readers and for whose frequent contributions to the Communique we are very grateful, describes the company model and the management fee model “other schemes” and explains why these are illegal if they represent payment to the ambulatory surgical center for giving physicians access to Medicare patients. Mr. Weiss’s article adds further clarity by placing the OIG’s June opinion in the context of earlier determinations.

A set of other frequent contributors, Abby Pendleton, Esq., Carey Kalmowitz, Esq. and Adrienne Dresevic, Esq., all members of the Health Law Partners firm, offer a complementary view of the company model advisory opinion. They remind us, notably, of the key role of the intent of the parties to a financial arrangement in which the entity controlling access to the patients receives remuneration from the anesthesiologists. If the purpose of the arrangement is to enhance quality and efficiency, there is no anti-kickback violation – unless even one purpose is to compensate the entity for patient referrals.

Read these two articles in tandem, and you will be very well equipped to understand whether a proposed deal in which you, the anesthesia practice, are asked to make any kind of economic contribution to the other party’s bottom line.

In my Spring 2012 Communique editorial, I suggested that the issue was a keeper because it laid out in a series of detailed tables the “meaningful use” measures of Stages 1 and 2 of the Medicare Electronic Health Record (EHR) incentive program. This issue, too, is intended as a keeper. Neda Mirafzali, Esq.’s article A Survey of State Prompt Pay Laws, Part I is a summary in tabular form of the statutes in all 50 states that penalize health plans that fail to pay providers for clean claims within the prescribed time frame. Knowing your rights to timely payment can be critical to effective A/R management.

The third in a series of articles by ABC Director of Client Services Arne Pedersen, MBA, FACMPE, Approaches to Collecting from Self Pay and High Deductible Patients, elaborates on some of the issues raised in the Summer 2012 issue of the Communique. We all recognize that anesthesiologists and other physicians or providers with whom the patient has a limited personal relationship can end up at the back of the line when it comes to collecting payment directly from the patient. Did you know that there are multiple medical credit cards that are one way for patients to finance their medical treatment—among other strategies?

Other ABC staff contributions include Vice President Jody Locke’s discussion of the benefits of and options for participating in Anesthesia Quality Databases, and Vice President Joette Derricks’s review of coding and documentation requirements in billing for transesophageal echocardiography. What other topics would you, our esteemed readers, like to see in future issues of the Communique? We will do our best to satisfy the interests that you share with us.

With best wishes,

Tony Mira
President and CEO