Ambulatory Surgery Centers ("ASCs") Subject to RAC and Other Medicare Audits

The Recovery Audit Contractor ("RAC") permanent program is now operating nationwide after the completion of a demonstration program, which the Centers for Medicare & Medicaid Services (“CMS”) deemed to be a success based on the large number of alleged “overpayments” identified. Like all providers, Ambulatory Surgery Centers ("ASCs") are potentially a target of the RACs and other CMS contractors. ASCs nationwide should prepare now for increased scrutiny of their Medicare claims.

Wachler & Associates, P.C., has represented providers, suppliers and other healthcare entities subject to Medicare audits and claim denials for over 25 years. During the RAC demonstration program, our firm represented numerous entities with their appeals of claim denials and overpayment determinations with very successful results. We have continued to successfully represent all types of providers in the RAC permanent program, as well as with regard to the defense of various other Medicare and third party payor audits.

Our attorneys have represented ASCs for many years in all facets of the ASC business. Our firm is frequently asked to speak to professional and provider organizations, including the Ambulatory Surgery Center Association (formerly known as the Federated Ambulatory Surgery Association ("FASA")) regarding various healthcare law topics. We understand the nature of ASC billing and can defend claims based on an improper application of inpatient global billing rules in the ASC setting – which is an area that the RACs have reportedly focused. The RAC contractors will also be reviewing ASC services provided to beneficiaries during a SNF stay.

In the event that your ASC is subjected to a RAC or other audit, our attorneys can help you provide the best defense possible under the circumstances. Please contact us for more information.

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The attorneys of Wachler & Associates often speak on audit issues that affect hospice and home health agencies. Please visit our Audit Speaking Engagements page to view a list of Wachler & Associate's audit speaking engagements.

Contact Us

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