Ambulatory surgical centers (ASCs) are one of the fastest-growing medical services now. However, unlike physician-surgeon or hospital billing, there are great things that you as well as your billing authority need to know before filing a claim for services provided through an ASC. Medicare often has several guidelines than some payers, for one thing, and the payers themselves often vary regarding medical urgency, approved procedures, or other filing obligations. If you’re brand-new to ASC billing, understanding these guide about Ambulatory Surgical Center (ASC ) billing services and recording claims upfront will get you off to a more reliable start and increase your likelihood of more active, more comprehensive reimbursement. However, even expert billers find that due to the ever-changing nature of payers, and Medicare, particularly the difficulty of staying current on the most progressive changes, it can be intimidating without the support of third-party dues management services.
Some basic ASC charges coded and billed?
An ASC uses a mixture of physician and hospital or clinical billing, applying each CPT and HCPCS level codes (as do most physicians); any insurance carriers allow an ASC to check using ICD-10 procedure codes, as performed in a hospital.
A few “packaged” services such as medical or surgical supplies are not on a “pass-through” status, surgical dressings, splints, casts, associated items, administration of an anesthesiologist by the practicing doctor, and so on.
Check for “not on pass-through” objects, such as supplies like these listed above or other “formed out” costs, which may be differently reported and paid separately. But, again, you could be blowing cash on the table by not taking the benefit of recognizing this itemization.
Device Intensive Procedures
Device-intensive procedures, such as inserting a pacemaker, adjust the Ambulatory Surgical Center (ASC) for the device but not as a separate line item. The center would accommodate the device’s cost in the procedure code and tender it as one-line item. As a rule, most ASCs cannot base their cost on the Medicare Physician Fee Schedule’s legal code.
Medicare currently claims all ASC charges to be filed electronically, practicing the CMS-1500 form, with most other insurers using the UB92 form. Medicare requires modifier SG when offering costs to indicate that they perform services from an ASC. Additional payers also may prefer to see the SG modifier to help differentiate between the facility’s bill and that of a physician. Regularly check with a particular insurer to manage their Ambulatory Surgical Center (ASC) billing requirements.
ASCs cannot base price on the allowable code from the Medicare Physician Fee Schedule (MPFS). If the 10 percent gain does not incorporate the cost of the device, it will not regain the funds. Therefore, it is essential to know the value of the Ambulatory Surgical Center (ASC) billing and add the expense of the device into the allowable.
Some Modifiers in the ASC to be known:
Some modifiers used in the ASC are identical to those used by physicians, while others are different to the ASC department. Modifiers acknowledged for ASC claim filing are (these are abbreviated information):
- 52 Reduced services
- 59 Distinct, separate procedure
- 73 Procedure discontinued after prepping for surgery
- 74 Procedure finished following anesthesia administered
- RT Right side
- LT Left side
- TC Technical component
- FB Device furnished at no cost/full credit
- FC Device provided at partial credit
- PT Screening service transformed to a diagnostic or therapeutic service
- PA Wrong body part
- PB Surgery wrong patient
- PC Wrong surgery on a patient
- GW Surgery not associated with the hospice patient’s concluding condition
ASCs possess their modifiers for an abandoned procedure. Modifier 73 Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure before the department of anesthesia is used when planning for surgery has begun, but anesthesia has not been given.
Alternatively, the patient is taken back to the “prep” area and has completed paperwork, etc. The logic may be that the patient has a low-grade temperature or has consumed food within four hours. The department charges for the preparation, etc., but appends the modifier to show it did not meet the procedure.
Modifier 74 Discontinued outpatient hospital/ambulatory surgery centers (ASC) procedure after administration of anesthesia is used when the system is terminated after anesthesia is administered. Plans can pay from 25 percent to 65 percent of the allowable amount, based on the modifier and documentation of how much performed the services.
New modifier PT Colorectal cancer screening test; converted to diagnostic test or other procedure indicates that a screening colonoscopy was converted to a diagnostic or healing service. For example, a patient present to the ASC for a screening colonoscopy. He is not high risk and has no indications or grievances. However, during the colonoscopy, a polyp is found in the sigmoid. As a result, the ASC reports 45380 Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple instead of 45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without gathering of specimen(s) by brushing or washing, with or without colon decompression (separate procedure) or G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk. Modifier PT designates the operation was planned as a screening but resulted as a diagnostic procedure. For Medicare patients, this allows the system to be paid as a screening with no co-insurance.
Commercial plans may or may not follow the policy for ASC claim filing. Check the carrier’s location for info on claim filing, and check your contract with the payer.
Some regulations for determining which methods are covered?
While dealing with Medicare, centers need to be informed that not all procedures recognized in a hospital are permitted in an ASC setting.
To be “approved” by Medicare, CMS has decided that a given procedure does not pose a significant safety risk or incurs a late admission following the process.
The approved list is based on the following principles:
- They cannot mean life-threatening or of an emergency nature, such as reattaching a severed limb or a heart transplant.
- Cannot securely complete procedures in a physician’s office
- They can be necessary
- They can be voluntary
General ASC coding mistakes
First, be assured that the ASC’s charges match with what was accomplished.
- One of the most basic medical coding mistakes is coding based on a procedure’s headings instead of the actual surgical record. Several ambulatory surgical centers and additional freestanding outpatient departments carefully wait for the perfect surgeon’s account rather than bill directly for registered services, as sometimes fewer (or different) methods are noted in the concluding report.
This is bound to end in rejection once it reaches the payer, so a coder should perpetually take the time to thoroughly read the complete operative record, with any discrepancies suspected.
- Other typical errors involve misreporting open and arthroscopic procedures as one method. It occurs when a process is started arthroscopically then, for whatever reason, is transformed into an available system. Many coders wrongly bill for both when simply the open procedure is the correct procedure to be coded. Ideally, this does not apply when the provider makes one approach arthroscopically with a different one using the available technique. As long as they are two other procedures, they can be billed instead of as one.
So, what kind of services are covered?
Considerably of what is or isn’t enclosed under ASC guidelines depends on the ASC facility status.
Suppose the facility is fully credentialed, with every certified aspect of an ASC. In that case, they’ll be able to perform many more procedures than if they were minimally qualified to perform certain functions.
Some services can be provided by an ASC which are considered covered, even though they’re not considered ASC services:
- Ambulance Services
- Artificial Legs, Arm, and Eyes
- Implantable Durable Medical Equipment
- Non-Implantable Durable Medical Equipment
- Leg, Arm, Back, and Neck Braces
- Physician’s Services
- Prosthetic Devices
How will 24/7 Medical Billing Services improve your revenue cycle?
We manage to reduce bottlenecks in your billing methods and assure regular payment inflows for your facility. Starting from identifying deceptions in your billing system to lowering them, each step we take will maximize your revenues. Our experts will cooperate with your ASC to fetch the best reimbursements from claims and reduce denials. But, that’s not it; partnering with 24/7 Medical Billing Services will help you in reducing overheads such as Ambulatory Surgical Center (ASC) billing staff turnover.
Our end-to-end medical billing and RCM solutions streamline the revenue cycle of your Ambulatory Surgical Centre, thus ensuring a regular flow of income. Furnishing surgical services is a critical task and one that cannot be interrupted with. From EMR implementation to Denial Management, our professionals assist you in each activity connected with your RCM process.
Our coders and billers are well-versed with ASC differences and are regularly updated with the ever-changing compliances and ICD codes. We have partnered with several ASCs and hospitals all over the United States to support them in raising their revenues. Our clients have had outstanding results after outsourcing the Ambulatory Surgical Center (ASC) billing process to us.