Becker's ASC Review

23 CODING & BILLING Driving business, practicing law. Colin Luke Birmingham | (205) 226-5717 colin.luke@wallerlaw.com Beth Vessel Nashville | (615) 850-8867 beth.vessel@wallerlaw.com Physician pays $6.75M, settles unneeded procedures allegations By Laura Dyrda A n Orlando, Fla.-based cardiologist paid millions to settle allegations he performed unnecessary ablations and vein stent procedures, the Justice Department said Sept. 15. Ashish Pal, MD, is accused of performing ablation and stent procedures on the veins of patients that were outside accepted medical practice standards. Many of the proce- dures were allegedly performed by ultrasound technicians outside of their scope of practice. Dr. Pal allegedly overstated the degree of reflux and diam- eter of the veins and falsely documented patients' symp- toms to justify billing for the procedures, according to the Justice Department. e physician paid $6.75 million to resolve the allegations. Dr. Pal and his practice, Interventional Cardiology & Vascular Consultants, entered into an integrity agreement with the Office of the Inspector General to complete train- ing and reporting requirements. CMS to take next step in site-neutral pay for off-campus clinics: 3 notes By Patsy Newitt C MS will move forward with site-neutral pay initiatives for outpatient clinic visits for hospital services provided at off- campus facilities. Three notes: 1. The agency plans to start reprocessing claims for outpatient clinic visits at off-campus provider-based departments Nov. 1 in accor- dance with the 2019 Outpatient Prospective Payment System final rule, which neutralized pay rates between all off-campus hospital departments and physician offices. 2. CMS will reprocess payments for services rendered during the 2019 calendar year, and providers will be required to refund coinsur- ance differences to patients who paid a higher rate. 3. The U.S. District Court for the District of Columbia declared the final payment rule invalid in September 2019, but the U.S. Court of Appeals for the D.C. Circuit reversed the decision in July 2020 to uphold the volume control site-neutrality payment policy. ASCs have been watching site-neutral policies closely and have championed CMS closing the gap in pay methodologies for hospital outpatient surgery departments and independent ASCs. CMS pays hospital outpatient departments at a higher rate than ASCs for the same procedures. n

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