Issue link: https://beckershealthcare.uberflip.com/i/976338
60 CODING & BILLING devices has also changed how prospective patients select providers for healthcare services; patients are "shopping" for surgery services and basing their de- cisions on cost, travel time, hospital affiliation and referral recommendations, according to Cardinal Health data. ASCs need to provide high-quality and low-cost care to recruit patients. To do that, Ms. Denegre- Rumbin encouraged centers to: • Ensure accountability for patient experience • Orient services around patient preference • Target marketing and service offerings to specific populations Consumerism is changing more than just ambula- tory business practices — private payers must meet consumer demands as well. Ms. Denegre-Rumbin said payers are now offering preference pricing, direct employer contracting, private bundles and procedure warranties to cater to patients. Finally, private payers typically favor ASCs com- pared to hospitals because of lower reimbursement rates. ASCs can capitalize on private payers by using payer data to target employers. Ms. Denegre- Rumbin recommends centers cra exclusivity agreements to drive volume and revenue to their center. To do that, ASCs need to demonstrate higher quality outcomes than the competition. n How Anthem's new anesthesia policy for cataract surgery will affect ASCs — 5 insights By Eric Oliver A nthem made a policy change that claimed monitored anes- thesia care during routine cataract surgery was not medically necessary, YubaNet.com reports. Here's what you should know. 1. The change is being met with resistance from several professional societies, including the California Academy of Eye Physicians and Surgeons and the California Society of Anesthesiologists. 2. Both societies are requesting that Anthem review the policy before a disastrous error takes place. 3. The societies also issued complaints to the California Department of Managed Health Care and the California Department of Insurance. 4. The groups argue a lack of monitored anesthesia care would put patients' sight at risk. If patients were to move at all during the proce- dure, the consequences could be sight altering. 5. If the policy remains in place, patients will either have to pay for monitored anesthesia care themselves or undergo a procedure in what anesthesiologists consider to be suboptimal conditions. n Riverside Regional Surgery Center owner, 3 others charged in $8M healthcare fraud scheme: 5 things to know By Laura Dyrda B abar Iqbal, MD, and three others were arrested yesterday on felony charges, alleging the co-con- spirators were involved in an $8 million healthcare fraud scheme, according to The Press-Enterprise. Here are five things to know: 1. Dr. Iqbal, who heads Riverside (Calif.) Regional Sur- gery Center, and three others are accused of devising a scheme to bill insurance for care given under false pretenses. An official for Springfield, Ill.-based Hospital Sisters Health System recommended $5 million be set aside for an insurance plan that would cover needy pa- tients and received a $1 million kickback in addition to a home purchase for the recommendation. However, when the patients arrived at Riverside Regional Surgery Center claiming to be employees of an orga- nization called Kingmakers, allegedly a shell company formed to funnel patients through, Dr. Iqbal told them Medi-Cal wouldn't cover treatment and advised them to sign up for a free health insurance policy. 2. UnitedHealthcare owned the free health insurance policy and paid $1 million on those claims; at the same time, $500,000 was given to Riverside Regional Surgery Center and put into an unlicensed charity. The money was delivered as written checks, sometimes indicat- ing they were donations, but the prosecutors claim the checks were kickbacks. 3. Investigators claim the defendants in total received $5 million of donations made under false pretenses, as well as $3 million in illegal kickbacks. One of the alleged co- conspirators has already spent time in a federal prison for his role in a $20 million mortgage fraud scheme. 4. Dr. Iqbal and the others face 33 counts of criminal charges, including grand theft, money laundering and tax evasion in addition to the healthcare fraud and con- spiracy charges. Bail for Dr. Iqbal is set at $3 million and arraignment is scheduled for Monday. 5. The California District Attorney and California Depart- ment of Insurance first began investigating Riverside Re- gional Surgery Center after 22 of 23 alleged Kingmakers employees received treatment there "within five weeks of getting health insurance policy, with initial claims totaling $4 million." n