Health care providers have complex legal needs, and this particularly holds true for Ambulatory Surgical Centers (ASCs). With years of experience providing a vast array of legal services to ASCs, Potashnik & Associates is able to offer strong and confident representation for your medical center.

Due to our extensive comprehension of the multitude of regulations governing ambulatory surgery centers, we’re able to provide counseling on a variety of issues. These include, but are not limited to:

• Abuse, fraud and waste counseling, inclusive of compliance with the Anti-Kickback Statute, ASC Safe Harbor and the Stark law
• Compliance with Medicare Conditions for Coverage, Medicare Conditions of Participation
• Payment and coding regulations associated with Medicare and Medicaid
• Audits and appeals, again relating to Medicaid and Medicare
• Audits and appeals relating to ZPIC, RAC and private payers
• Compliance with the Health Insurance Portability and Accountability Act (HIPAA), including HIPAA breach notification and privacy issues
• ASC development, as well as joint ventures with hospitals, doctors or health care systems
• Sale or purchase of equity interests
• Transactional and contractual agreements
• Licensing issues and Certificates of Need
• Corporate governance, operations and structural issues
• Additional matters related to industry regulations or health care law

The breadth of our knowledge and experience goes wide, and it also goes deep. A few of the most prominent areas in which the attorneys at Potashnik & Associates have experience include:

While joint ventures between ASCs and health systems, hospitals and doctors may appear rather straightforward on the surface, it is certainly not the case. They can be fraught with a number of compliance issues, particularly if the transaction would result in the passing along of referrals from the new owners to the existing owners. To ensure no complications arise in such instances, legal consultation is a necessity. We are here to provide it.

Buying and Selling ASCs: Purchasing an ambulatory surgical center can be just as complex as forming a joint venture, and membership interests must be carefully considered. Diligence is required to ensure the seller is compliant with regulatory claims submission and Medicare claims submission requirements. It’s also vital that buyers know the appropriate actions that must be taken to transfer Medicare certificates of need and billing privileges.

Sellers have their own slate of issues, such as member admissions as well as voluntary and involuntary terminations associated with ASC safe harbors. The lawyers at Potashnik & Associates have the experience needed to advise and guide clients forward to the smooth sale or purchase of an ASC.

Compliance Plans: One of the most pressing concerns for ASCs is related to Medicare, specifically its Conditions of Participation and Conditions for Coverage. Navigating through the Medicare territory can be treacherous without trust legal counsel by your side. Our lawyers are also able to advise clients on additional issues, such as Medicare reimbursement regulations, HIPAA compliance, federal anti-kickback statutes and Stark law. Our experience drafting documents is vast, and it includes drafting security and privacy manuals that have been highly respected in the health industry.

Audits: An aggressive line of defense is required in an audit, and that defense must come from a legal team who is intricately familiar with all stages of the auditing process. Appeals are one of the most important stages of the process, making it essential to have representation that is well-versed in appeals. The attorneys at Potashnik & Associates are leaders in the areas of Medicare, Medicaid, MAC, RAC, ZPIC and third-party payer audits.

Our vast experience with the appeals process allows us to work ardently with clients through every single phase. This applies to clients that have been placed on pre-payment review or even payment suspension. We provide a tailored approach that aligns with each client’s needs, drafting position papers, written submissions and other required documents especially for your case.

Because health care law is always evolving, it’s important to be aware of the recent experiences of a particular legal team. We here at Potashnik & Associates are proud to have recently focused on the following areas:

• HIPAA violations
• Out-of-network business with payers
• Compliance with sales of equity interests
• Compliance with regulatory safe harbors
• Compliance with model arrangements

The Medicare and Medicaid Services Ambulatory Surgical Center webpage can be accessed here (need to add link – wasn’t included in original copy)

We have written a number of articles relating to ASCs, which you can access here (need to add link – wasn’t included in original copy)

The lawyers at Potashnik & Associates are available to speak on a wide scope of issues related to ASCs, including health care law and audits. To have one of our lawyers speak at your event, place contact our office.

If you have additional questions that have not yet been answered, please contact us to schedule a consultation. Contact Potashnik & Associates by phone: 212-577-6677, or by email: jp@jpolawfirm.com.