Intercoastal Medical Group Ambulatory Surgery Center
3333 Cattlemen Road, Suite 100
Sarasota, FL 34232 link
to map
Tel: (941) 379-5884 • Fax: (941) 379-1760
Our Mission
At Intercoastal Medical Group Ambulatory Surgery Center,
our mission is to provide every patient with the finest
quality medical care that is cost effective in a warm,
personalized
setting and to treat every patient with courtesy and respect.
The following navigation links have been compiled to introduce
you to our center and to help you make informed and educated
decisions regarding your treatment.
Our 10,500 square foot multi-service facility is Medicare
certified and licensed by the State of Florida. The facility
has also received accreditation by the Accreditation
Association for Ambulatory Health Care (AAAHC), which
means that the
surgery center has passed a series of rigorous and nationally
recognized standards for the provision of quality health
care, as set by the AAAHC.
We offer state-of-the-art equipment and highly trained
staff to assure your comfort and safety. Our nurses are
Advanced
Cardiac Life Support (ACLS) and Pediatric Advanced Life
Support (PALS) trained. Our anesthesiologists and physicians
are
board certified. Our experienced staff performs more
than 6,000 procedures a year in:
• Gastroenterology/endoscopy
• Orthopedics
• General surgery
• Ear, nose and throat (pediatric and adult)
• Gynecology
• Podiatry
• Plastic Surgery
• Pain Management
• Urology
PHYSICIAN OWNERSHIP
The physicians listed below may have a “beneficial
interest” in Intercoastal Medical Group Ambulatory
Surgery Center. An interest in this facility enables
them to have a voice in the administration and medical
policies
of this health care institution. This involvement helps
to ensure the finest quality of care for their patients.
Intercoastal
Medical Group Ambulatory Surgery Center places special
emphasis on fully informing our patients of this ownership.
It is
our goal to inform you and treat you professionally at
all times.
You have the right to choose another facility in which
to receive the services your Physician has determined are
necessary.
Pre-procedure
Our center is dedicated to providing the highest quality
health care while reducing costs. Surgical and diagnostic
procedures are performed in safe, clean surroundings by
experienced, caring staff. Anesthesia is given in a manner
that allows patients to return to their homes the same
day.
The more involved and informed you are, the safer and more
pleasant this experience will be.
Our Job is to:
• Provide a safe place and caring staff for your procedure.
• Call you from our Business Office regarding financial obligations,
if applicable.
• Call you with instructions and confirm the time for you to
arrive at the Center. This will be done by our nursing
staff .
• Call a day or two after your procedure to check on you. The
nurses will not have any results of your tests or lab work.
Your doctor provides these to you.
• Without your prior written approval, please understand that
we cannot leave messages on your answering machine.
• Send you home with a responsible adult to rest and recover.
Your Job is to:
• Arrange to be driven and accompanied home by a responsible adult who
can remain with you for 24 hours. THIS IS REQUIRED OF ALL PATIENTS. You may
take a cab,
as long as you have another adult (family member, friend, etc.) with you.
• Tell your doctor about any medications you take including aspirin, blood
thinners, herbs, vitamins, or diabetic medications. Ask if you should continue
taking
them prior to or immediately following your surgery.
• Notify your doctor as soon as possible, if you cannot keep your appointment.
• No food or drink, including water, after midnight prior to your surgery
or procedure.
Special Health Concerns:
•
If you are diabetic, please follow your doctor’s instructions about
your diabetic medication before coming to the Center the day of your surgery/procedure.
• If you have a pace maker or internal defibrillator, please notify your
doctor. Often, patients with these devices will need to make arrangements to
have it
turned off just prior to surgery.
• If you have asthma or use an inhaler, please bring your inhaler with
you the day of surgery.
• Please notify your doctor and our Center about any known allergies you
may have to any medications, as well as to dyes, rubber, or latex.
• If you have ever had symptoms of what may be a latex allergy, please
notify your doctor and our Center. These symptoms include: rash, watery eyes,
or difficulty
breathing after using rubber gloves, latex condoms, blowing up a balloon,
or any diagnostic procedures or dental visits.
• Please let your doctor or our Center know if you have special communication
needs. We will attempt to meet your needs whenever possible.
• Please notify us if you have any religious or cultural issues that would
affect your health care or treatment.
Children’s Surgery
•
Notify your child’s surgeon of any changes in his/her physical condition
that might cause cancellation or rescheduling surgery- for example, a cold,
fever, or persistent cough.
• Let your child bring a favorite toy or blanket on the day of surgery.
• For safety reasons, only two adults are allowed with the child in pre-operative
holding area. One adult must remain with the child at all times until they
are moved to the operating room. If you have other children with you, they
will not be allowed in the pre-operative holding area. It is your responsibility
to have someone else supervise your other children at all times.
• Have one adult tend to the child in the car on the way home and another
adult drive.
Facility Policies
Medicare’s new condition of coverage has mandated that patients must
be given in writing and verbal notification of patient’s rights and
the centers ownership before the day of their procedure.
The facility’s policy on Advance Directives
Most procedures done in an ASC setting are considered to be of minimal risk.
If an adverse effect occurs during your treatment at this facility, all means
of resuscitation or stabilizing measures will be performed and you will be
transferred to an acute care hospital for further evaluation.
At the acute care hospital, further treatment or the withdrawal of treatment
will be ordered in accordance with your wishes, advance directive, or health
care Power of Attorney.
Your rights and responsibilities as a patient
You have the right to personal privacy and confidentiality of your clinical
records, to receive care in a safe setting and be free from all forms of
abuse or harassment. You have the responsibility to provide accurate medical
and
insurance information and to follow the health care facility rules and regulations
affecting patient care and conduct.
Your Physician’s Ownership in the
facility
Your Physician may have a “beneficial interest” in this Surgery
Center and you have the right to choose another facility in which to receive
the services your Physician has determined are necessary. Please refer to
the Physician Ownership section of this website.
The submission process and
handling
of grievances
You have the right to voice any grievances regarding your treatment or care.
You can file a grievance with the facility’s appointed representative
by calling (941) 379-5884 or through the Office of the Medicare Beneficiary
Ombudsman by visiting www.medicare.gov.
Advance Directives/
Living Will
Most procedures done in a surgery center setting are considered to be of minimal
risk. If an adverse effect occurs during your treatment at this facility, all
means of resuscitation or stabilizing measures will be performed and you will
be transferred to an acute care hospital for further evaluation.
At the acute care hospital, further treatment or the withdrawal of treatment
will be ordered in accordance with your wishes, advance directive, or health
care Power of Attorney.
• You can provide the facility with a copy of your Advanced Directive /
Living Will / Health Care Proxy.
• The Facility does not honor this document
• I agree to proceed with the proposed procedure as scheduled.
• The facility can provide information on how I can obtain an
Advanced Directive / Living Will / Health Care Proxy.
Notice
of Privacy Practices
NOTICE OF PRIVACY PRACTICES
Effective Date: April 14, 2003
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please contact
the Facility Privacy Official by dialing the main surgery
center number.
Each time you visit a surgery center, hospital, physician,
or other healthcare provider, a record of your visit
is made. Typically, this record contains
your symptoms, examination and test results, diagnoses, treatment, a plan
for future
care or treatment, and billing-related information. This notice applies to
all of the records of your care generated by the facility, whether made by
facility personnel, agents of the facility, or your personal doctor. Your
personal doctor may have different policies or notices regarding the doctor’s
use and disclosure of your health information created in the doctor’s
office or clinic.
Our Responsibilities
We are required by law to maintain the privacy of your health information
and provide you a description of our privacy practices. We will abide by
the terms
of this notice.
Uses and Disclosures
How we may use and disclose Health Information about you.
The following categories describe examples of the way we use and disclose
health information: • For Treatment: We may use health information about you to provide you treatment
or services. We may disclose health information about you to doctors, nurses,
technicians, medical students, or other surgery center personnel who are
involved in taking care of you at the surgery center. For example: a doctor
treating
you for a broken leg may need to know if you have diabetes because diabetes
may slow the healing process. Different departments of the surgery center
also may share health information about you in order to coordinate the different
things you may need, such as prescriptions, lab work, meals, and x-rays.
We may also provide your physician or a subsequent healthcare provider with
copies of various reports that should assist him or her in treating you once
you’re discharged from this surgery center. • For Payment: We may use and disclose health information about your treatment
and services to bill and collect payment from you, your insurance company
or a third party payer. For example, we may need to give your insurance company
information about your surgery so they will pay us or reimburse you for the
treatment. We may also tell your health plan about treatment you are going
to receive to determine whether your plan will cover it.
• For Health Care Operations: Members of the medical staff and/or quality improvement
team may use information in your health record to assess the care and outcomes
in your case and others like it. The results will then be used to continually
improve the quality of care for all patients we serve. For example, we may
combine health information about many patients to evaluate the need for new
services or treatment. We may disclose information to doctors, nurses, and
other students for educational purposes.
And we may combine health information
we have with that of other facilities to see where we can make improvements.
We may remove information that identifies you from this set of health information
to protect your privacy.
We may also use and disclose health information:
• To business associates we have contracted with to perform the agreed upon
service and billing for it;
• To remind you that you have an appointment for medical care;
• To assess your satisfaction with our services;
• To tell you about possible treatment alternatives;
• To tell you about health–related benefits or services;
• To contact you as part of fundraising efforts;
• To inform Funeral Directors consistent with applicable law;
• For population based activities relating to improving health or reducing
health care costs; and
• For conducting training programs or reviewing competence of health care
professionals.
When disclosing information, primarily appointment reminders and billing/collections
efforts, we may leave messages on your answering machine/voice mail.
• Business Associates: There are some services provided in our organization
through contracts with business associates. Examples include physician services
in
radiology, certain laboratory tests, and a copy service we use when making
copies of your health record. When these services are contracted, we may
disclose your health information to our business associates so that they
can perform
the job we’ve asked them to do and bill you or your third-party payer
for services rendered. To protect your health information, however, we require
the business associate to appropriately safeguard your information.
• Directory: We may include certain limited information about you in the facility
directory while you are a patient at the surgery center. The information
may include your name, location in the surgery center, your general condition
(e.g.,
good, fair) and your religious affiliation. This information may be provided
to members of the clergy and, except for religious affiliation, to other
people who ask for you by name. If you would like to opt out of being in
the facility
directory please request the Opt Out Form from the admission staff or Facility
Privacy Official. • Individuals Involved in Your Care or Payment for Your Care: We may release
health information about you to a friend or family member who is involved
in your medical care or who helps pay for your care. In addition, we may
disclose
health information about you to an entity assisting in a disaster relief
effort so that your family can be notified about your condition, status and
location.
• Research: We may disclose information to researchers when an institutional
review board that has reviewed the research proposal and established protocols
to ensure the privacy of your health information has approved their research
and granted a waiver of the authorization requirement.
• Future Communications: We may communicate to you via newsletters,
mail outs or other means regarding treatment options, health related information,
disease-management
programs, wellness programs, or other community based initiatives or activities
our facility is participating in. • Organized Health Care Arrangement: This facility and its medical staff members
have organized and are presenting you this document as a joint notice. Information
will be shared as necessary to carry out treatment, payment and health care
operations. Physicians and caregivers may have access to protected health
information in their offices to assist in reviewing past treatment as it
may affect treatment
at the time.
• Affiliated Covered Entity: Protected health information will be made available
to facility personnel at local affiliated facilities as necessary to carry
out treatment, payment and health care operations. Caregivers at other facilities
may have access to protected health information at their locations to assist
in reviewing past treatment Information as it may affect treatment at this time.
Please contact the Facility Privacy Official for further information on the
specific sites included in
this affiliated covered entity.
As required by law, we may also use and disclose health information for the
following types of entities, including but not limited to:
• Food and Drug Administration
• Public Health or Legal Authorities charged with preventing or controlling
disease, injury or disability
• Correctional Institutions
• Workers Compensation Agents
• Organ and Tissue Donation Organizations
• Military Command Authorities
• Health Oversight Agencies
• Funeral Directors, Coroners and Medical Directors
• National Security and Intelligence Agencies
• Protective Services for the President and Others
Law Enforcement/Legal Proceedings: We may disclose health information for
law enforcement purposes as required by law or in response to a valid subpoena.
State-Specific Requirements: Many states have requirements for reporting
including population-based activities relating to improving health or reducing
health
care costs. Some states have separate privacy laws that may apply additional
legal requirements. If the state privacy laws are more stringent than federal
privacy laws, the state law preempts the federal law.
Your Health Information Rights: Although your health record
is the physical property of the healthcare practitioner or facility that
compiled it, you have the Right to:
• Inspect and Copy: You have the right to inspect and obtain a copy of the
health information that may be used to make decisions about your care. Usually,
this includes medical and billing records, but does not include psychotherapy
notes. We may deny your request to inspect and copy in certain very limited
circumstances. If you are denied access to health information, you may request
that the denial be reviewed. Another licensed health care professional chosen
by the facility will review your request and the denial. The person conducting
the review will not be the person who denied your request. We will comply
with the outcome of the review.
• Amend: If you feel that health information we have about you is incorrect
or incomplete, you may ask us to amend the information. You have the right
to request an amendment for as long as the information is kept by or for
the surgery center.
We may deny your request for an amendment and if this occurs, you will be
notified of the reason for the denial.
• An Accounting of Disclosures: You have the right to request an accounting
of disclosures. This is a list of certain disclosures we make of your health
information for purposes other than treatment, payment or health care operations
where an authorization was not required.
• Request Restrictions: You have the right to request a restriction or limitation
on the health information we use or disclose about you for treatment, payment
or health care operations. You also have the right to request a limit on
the health information we disclose about you to someone who is involved in
your
care or the payment for your care, like a family member or friend. For example, you
could ask that we not use or disclose information about a surgery you had.
We are not required to agree to your request. If we do agree, we will comply
with your request unless the information is needed to provide you emergency
treatment.
• Request Confidential Communications: You have the right to request that
we communicate with you about medical matters in a certain way or at a certain
location. For example, you may ask that we contact you at work instead of
your
home. The facility will grant reasonable requests for confidential communications
at alternative locations and/or via alternative means only if the request
is submitted in writing and the written request includes a mailing address
where
the individual will receive bills for services rendered by the facility and
related correspondence regarding payment for services. Please realize, we
reserve the right to contact you by other means and at other locations if
you fail
to respond to any communication from us that requires a response. We will
notify you in accordance with your original request prior to attempting to
contact
you by other means or at another location.
• A Paper Copy of This Notice: You have the right to a paper copy of this
notice. You may ask us to give you a copy of this notice at any time. Even
if you have
agreed to receive this notice electronically, you are still entitled to a
paper copy of this notice.
If the facility has a website you may print or view a copy of the notice
by clicking on the Notice of Privacy Practices link.
To exercise any of your rights, please obtain the required forms from the
Privacy Official and submit your request in writing.
CHANGES TO THIS NOTICE
We reserve the right to change this notice and the revised or changed notice
will be effective for information we already have about you as well as any
information we receive in the future. The current notice will be posted in
the surgery center and include the effective date. In addition, each time
you register at or are admitted to the surgery center for treatment or health
care
services as a patient, we will offer you a copy of the current notice in
effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint
with the facility by following the process outlined in the facility's Patient
Rights documentation. You may also file a complaint with the Secretary of
the Department of Health and Human Services. All complaints must be submitted
in
writing.
You will not be penalized for filing a complaint.
OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of health information not covered by this notice
or the laws that apply to us will be made only with your written permission.
If you provide us permission to use or disclose health information about
you, you may revoke that permission, in writing, at any time. If you revoke
your
permission, we will no longer use or disclose health information about you
for the reasons covered by your written authorization. You understand that
we are unable to take back any disclosures we have already made with your
permission, and that we are required to retain our records of the care that
we provided
to you.
Patient Information
:
PATIENT'S RIGHTS AND RESPONSIBILITIES
This facility and medical staff of Intercoastal Medical
Group Ambulatory Surgery Center have adopted the following
list
of patient rights and responsibilities. This list shall
include, but is not limited to:PATIENT RIGHTS
The patient has the right:
• To impartial treatment without regard to race, color, sex,
national origin, religion, handicap or disability.
• To exercise his or her rights without being subjected to
discrimination or reprisal.
• To be free from all forms of abuse or harassment.
• To receive considerate and respectful care at all times and
under all circumstances.
• To know of the name and professional status of those caring
for him or her.
•
To receive information from the physician about his or her
diagnosis, treatment plan and prognosis to the best of the
physician’s knowledge.
• To participate actively in decisions regarding your medical
care. To the extent permitted by law, this includes the right
to refuse treatment.
• Of full consideration of privacy concerning your medical
care program. Case discussion, consultation, examination
and treatment are confidential and should be conducted discretely.
• To be informed that advanced directives cannot be honored
in this facility and to be advised that should an unexpected,
life threatening event occur, the patient will be transferred
to a facility that will honor there directive.
• To confidential treatment of all communications and records
pertaining to care. Written permission shall be obtained
before medical records can be made available to anyone not
directly involved with your care.
• To receive responsible responses to any reasonable requests
for service.
• To leave the facility even against medical advice.
• To expect reasonable continuity of care.
• To be advised if the physician proposes to engage or perform
experimentation affecting your care or treatment and the
right to refuse to participate in the activity.
• To be informed of the continuing health care requirements
following discharge from the center.
• To examine and receive an explanation of a bill for service,
regardless of source of payment.
• To report any comments concerning the quality of care provided
to you and expect follow-up on your comments.PATIENT RESPONSIBILITIES
The Patient is responsible:
• For providing accurate and complete information concerning
his present complaints, past medical history and other matters
relating to their health.
• For notification of the existence of an advanced directive
(as a living will) as those cannot be honored in this facility.
• For making it known whether they clearly comprehend the course
of their treatment and what is expected of them.
•
For following the treatment plan established by the physician,
including the instructions of nurses and other health care
professionals as they carry out the physician’s orders.
• For keeping their appointment and notifying the facility
if they are unable to do so.
• For providing a responsible adult to drive them home and
stay with them for 24 hours after surgery.
• For providing complete and accurate insurance information
(if applicable) and assuring that the financial obligations
of their care are fulfilled as promptly as possible.
• For being considerate of the rights of other patients and
facility personnel.
Financial Policies
and Process
Recognizing the need for patients to understand what
is expected regarding payment of medical services, we
have
established
our financial policy. Some of these items are required
by law.
• We will help you with the insurance process. We may
call you before the procedure regarding your insurance coverage.
•
You will be asked to sign an “assignment of benefits” form
so that the payment comes directly to our Center. Your
co-pay, deductibles, or co-insurance will be collected
at the time
of admission.
• If you have any questions regarding insurance coverage and
pre-approval requirements, please call our Business Office
at 379-5884.
• The Center bill does not include any services from
your surgeon, gastroenterologist, anesthesiologist, or any
lab/pathology services.
• If your doctor should change the scheduled procedure or perform
additional procedures, you may be responsible for additional
payment.
• All co-pays and co-insurance required by your insurance company
must be paid at the time services are rendered. We accept
cash, checks, Visa, MasterCard, and Discover.
•
It is the patient’s responsibility to be aware
of the contract benefits of his/her insurance carrier.
If your insurance
requires referrals/pre-authorization for full benefits
to be paid, it is your responsibility to verify that
the referrals/pre-authorizations
are in place prior to your visit.
• Our facility will file both primary and secondary insurance
claims for medical services rendered. Claims for a third
insurance contract will not be filed. We cannot file
claims correctly without accurate information from you. Proof of
insurance must be presented at each visit.
• If you do not have insurance, payment in full is expected
at the time of service.
•
You will receive a statement from our office within 30 days
of your insurance company’s response. If you are dissatisfied
with their payment, please contact your insurance carrier.
Payment of the patient’s portion of the balance
is due upon receipt of the statement.
•
We are participating providers for Medicare.. This means
that we must accept Medicare’s allowed charge for
the services rendered. Medicare will pay 80% of the approved
amount. The patient is responsible for the remaining
20%
plus any out-of-pocket deductibles. We will write off
the difference between what we charge and what Medicare
approves.
If you have secondary insurance, we will submit the claim
for the remaining balance after Medicare has paid. Please
remember that although we accept assignment for Medicare,
the patient by federal law, must be held responsible
for any portion of the approved amount not paid by Medicare
or
a secondary insurance company.
• Responsibility for payment for services rendered to the child/children
of divorced or separated parents rests with the parent
who seeks treatment. Any court ordered judgment must be between
the individuals involved, without including our facility.
• All accounts that are 60 days or more past due, may be turned
over to a collection agency.
• In the unlikely event your payment is returned unpaid, we
may elect to re-present your payment to your financial
institution up to two more times.
It is our hope that you will find this information helpful.
If you have questions, please speak with our billing
staff at (941) 379-5884.
Visitor's Information:
• We prefer that young children DO NOT accompany patients and
family members to the Center. If there is a delay, it
can be very tiring for children to wait in the lobby for extended
periods of time.
• Due to limited seating capacity in the lobby, we prefer you
limit the number of visitors who accompany patients.
• There is adequate parking at our Center.
• We have coffee, tea, vending machines, television and magazines
in our Family Waiting Room for your convenience.
• You may want to bring a sweater. The lobby may feel cold
to some people.
•
The doctor will speak to the family or significant others
after the patient’s surgery/procedure. Please provide
us with the names of the people who may speak with the
doctor.
