One of the fastest-growing medical services in the healthcare industry is the Ambulatory Surgical Centres (ASC). However, with the rise in the ASC, there are a few things that the medical billing department needs to know about when it comes to ASC medical billing before filing the claims for the services they have rendered.
One needs to be aware of Medicare’s different guidelines for ASC and the payers. Moreover, the payers have different medical approval procedures and other necessities when filling in the requirements for the operations.
As a result, even the experienced ASC billers sometimes find it challenging to keep them updated in managing the claims. That’s why the providers and the healthcare facilities usually prefer to partner with medical billing companies.
As the ASC medical billing and coding are different and a bit more challenging than the typical physician billing claims, there is often room for claim denials and loss of revenue.
Hence, it is always worthwhile to have comprehensive knowledge about Ambulatory Surgical Centers (ASC) medical billing if you are a provider of it.
In some cases, certain insurance companies allow the ASC to use the ICD-10 procedure codes when billing. In addition, often, a combination of physician and clinical or hospital billing is used in ASC along with CTP and HCPCS level codes. Hence, it is advisable to be aware of some of the basics when it comes to ASC medical coding and billing.
- There is a difference between packaged service and pass-through status. For instance, the splints, surgical clothes, associated materials, casts, and supervision of the anesthesiologist by the operating surgeon will be part of the packaged services when they aren’t in the pass-through status.
- The cost of the device in a device-intensive operation will be part of the procedure code and must be submitted under a single item. This translates to the fact that ASCs are not allowed to charge for the services based on codes allowed under Medicare Physician Fee Schedule
- Medicare needs ASC charges to be submitted using the CMS-1500 form instead of the UB92 form and must be done electronically.
- Additionally, the modifier SG must be used to indicate the ASC-provided services when charges are reported to Medicare. But it is always best to check the ASC medical billing restrictions that an insurance company has when the claims are made.
Healthcare facilities must be aware of the proper procedures in the ASC setting. Hence for any procedure authorized by the Medicare that can be conducted in an ASC establishment, the CMS must ensure that there is no considerable harm or risk factor where the patient needs to stay overnight after the treatment.
Here are some of the criteria that form the basis of the approved list for procedures conducted in ASC.
- The urgency of the treatment.
- It can be an elective.
- The procedure cannot be done safely in the physician’s office.
- The procedure is not emergency in nature or is life-threatening.
Common Errors In ASC Billing & Coding
Most ASCs face a wide range of issues regarding ASC billing and coding. It can be categorized into two- Operational Billing Errors and Coding Errors.
Here is a brief overview of the two:
In the years of experience providing medical billing and coding services to Ambulatory Surgical Centers (ASC’s), we have come across different reasons for coding errors. One of that is due to the operational mistake of an establishment. The reasons for the faulty operation can be due to:
Many facilities, in the process, cut costs, reduce their staffing and handle multiple jobs with that limited employees. Mistakes are bound to happen when they are overworked and handling different jobs. In such a case, consider outsourcing the tasks to an experienced medical billing and coding company that has expertise in billing and coding for Ambulatory Surgical Centers. As a result, you will save time and money in the long run.
Faulty and Misguided Definition of Procedures
It is mandatory to finish the documentation of the procedures done with an eye on details. Any unclear elements in the billing and the lack of definition of the procedures provided for the surgery will result to claim rejection. Also, as a practitioner, you should not assume your employees will know about the additional procedures implemented in ASC billing. Therefore, you need to add them to the document.
Lack Of Tracking No-Denials
Your practice may have the staff at the top of the game. They may be resolving issues with the payments from the patients and processing the claims on time. However, if they fail to track the claim denials, it’s a gateway to closing the revenue. Hence, it is a must that a system is put in place to track the details and know the reason for rejection and how it can be corrected. The entire process will warrant a better denial management system and improve the cash flow.
At times the reporting error in the bills can be the result of coding issues. The following pointers can help avoid coding mistakes when writing the report for the claim.
Keeping Updated With Forms
With the coding system continually updated and changed, the use of old forms for patient encounters would mean rejection of the claims. However, old forms can also fail to list the recent codes. In addition, in many cases, a year-old form can be outdated. Hence it would help if you keep updating it.
Lack Of Detailed Reporting
Open operations are pretty expensive, so when you report a technique that started with another treatment and led to an open operation, you must give a full report. However, it will not leave the coding staff confused about what you are trying to mention.
Use of Inaccurate Modifier
One of the significant reasons for claim denials is the mistakes in using the correct modifier. It can be due to the coder’s oversight or the lack of details in the reporting. So when you are conducting a procedure, ensure you write a detailed document and the coding is cross-checked before filing.
Outsource your ASC to 24/7 Medical Billing Services – The Ultimate Solution!
In ASC billing, all the above-mentioned factors ensure that you must get paid fully for all the services done. However, the ASC medical billing and coding procedure is not as straightforward as for other specialties, but it can be handled when outsourced to an experienced and know about ASC medical billing and coding company like 24/7 Medical Billing Services. The strong knowledge of the team of experts in ASC billing and coding will ensure your practice has no revenue loss for any procedures you do.