ASC Or Ambulatory Surgical Centers are regarded as a fast-growing medical service in the healthcare sector. With the increase in the total number of Ambulatory Surgical Centers, there are certain things the medical billing department should keep in mind, as the ASC billing files the claims for the specific services. It is essential that you should have the prerequisite information about the various ASC billing guidelines along with the payers. Besides this, the payers should have various medical approval processes and different necessities to fill the operations’ needs.
Henceforth, the experienced ASC billers find that it is difficult to remain updated to manage the specific claims. Hence, the healthcare facilities and the service providers try to partner with the medical billing service providers.
Since the medical billing and coding of the Ambulatory Surgical Centers are different and more challenging than the regular Physician billing claims, you might run the risks of revenue loss and claims denials. In this write-up, you can seek information about the ASC billing services, offered by the medical billing department:
What does ASC mean in billing?
According to the Medicare Carriers Manual, ASC or Ambulatory Surgical Centers are regarded as a unique and separate organizations, which can offer outpatient ASC Billing and Coding Services and treatment to the patients. The hospital-run facilities for medicare purposes are known to be provider-based hospital departments or the Ambulatory Surgical Centers.
If you want to have the eligibility for the medicare payments, it is essential that ASC should sign the participating provider agreement with CMS or Centers for Medicare and Medicaid Services. In addition, the CMS has come up with the bed-less hospital with the majority of the outpatient service, thereby decreasing the costs.
Besides this, the ASC Billing and Coding Services include the same-day surgery with different patients, who opt for the treatment at home. However, they will be in contact with the service providers through digital means. Such facilities play an integral role in re-defining ambulatory care since they will act as the one-stop solution for faster medical solutions.
What is asc in medical billing?
In certain cases, the insurance companies enable the Ambulatory Surgical Centers to make the right use of ICD-10 procedure codes during billing. Besides this, a prerequisite combination of the hospital, clinic and physical billing is used on an exclusive scale during Ambulatory Surgical Centers along with the HCPCS and CTP level codes. Thus, it is recommended to seek information about the basics of Ambulatory Surgical Centers medical billing and coding.
The price of the specific device, which is used during device-intensive operation, is considered to be an integral part of the specific procedure code. In addition, it should be submitted under the singular item. So, the Ambulatory Surgical Centers do not have the permission to charge money for the services, they provide on the codes, that are granted under the Medicare Physician Fee Schedule.
There is a difference between the pass-through status and the packaged service. The anesthesiologist’s supervision, casts, surgical clothing, splints, and the associated materials are regarded as the integral part of the packaged services, as they are not present during the pass-through status.
With the use of the modifier SG, the ASC-provided services receive the indication that certain charges get reported to Medicare. However, it is recommended to check out the ASC medical billing restrictions, that the insurance company receives, once the claims will be made.
Medicare should ensure to submit the ASC charges through the use of the CMS-1500 form, in place of the UB92 form. Medicare should take the prerequisite charges to perform it electronically.
CMS Regulations
It is essential that the centers should remember that every operation in the hospital is not allowed within the Ambulatory Surgical Center Setting. If you want that the Medicare should authorize the process, the CMS should establish that it will not establish the harm risks or the overnight stay needs, after the treatment. To clear your doubts, it is recommended to reach out to Medicare.
The below-mentioned criteria are considered to be the basics for the specific approved procedures list:
- They should be elective
- Whether it is urgent
- When the medical service provided will not be capable of performing the specific processes within the physicians’ office safely
- The process should not be of an emergency nature or life-threatening, like the heart transplant or the reattachment of the severed limb.
How to avoid common asc billing mistakes?
In this section, we will discuss the common errors, which are associated with the ASC medical billing and coding company:
Lower staffing
There are a bunch of facilities, included within Physician Billing Services which decrease the Billing and coding staff, reduce the costs, and handle a variety of jobs with the limited employees. Mistakes will occur if the employees are managing too many jobs at once. Hence, you should ensure to outsource the tasks to the experienced medical billing and coding company with the prerequisite expertise and experience in ASC billing and coding. It will offer a helping hand in saving an ample amount of money and time in ASC billing.
Using incorrect modifiers
There are a plethora of times when the claims are rejected in ASC billing owing to the use of the wrong modifiers. Such mistakes might occur owing to the absence of details within the reporting or the coder’s oversight. Hence, if you perform a specific process, you should ensure to include the detailed document, and cross-check the coding before filing.
Absence of detailed reporting
You should remember that open surgeries involve a huge cut-off from the pocket. Hence, it is recommended to report the process, which begins with other treatments and allows the open operations, thereby offering a full report. But, the ambulatory surgery coding staff, included in ASC billing, will not be confused about the staff, you try to include.
During ASC billing, the above-given factors should assure that you should be paid for the given Medical Billing Services completely. But the Ambulatory Surgical Centers are not as simple as other specialties. Hence, you should make sure to outsource it to the ASC billing companies, offering ASC billing and revenue cycle management services. They include a team of experts in the ASC billing and coding, who assures that the practice does not have any revenue loss for the specific processes. If you are looking to outsource your organization’s medical billing services, Synergy HCLS can be an excellent choice.
