ASC billing is not the same as traditional physician billing or facility billing. In contrast to physician medical billing, which needs to adhere to a few highly specialized rules to be reimbursed, ASC coding and billing are not focused on a specific medical specialty. As ASCs combine every medical specialty in one location, the coding system does not revolve around certain types of treatments, procedures, or diagnoses.
This does not imply that being an ASC biller necessitates knowing a totally new set of codes or billing procedures. ASC billing follows all of the same codes, billing process, and billing and coding criteria as the rest of the medical sector. Let’s have a look at some of the rules of ASC billing and coding services:
Guidelines for ASC Charges Billing & Coding
An Ambulatory Surgery Centre uses a combination of physician and clinical or hospital billing by utilizing the CPT and HCPCS level codes (as do most physicians). In fact, some insurance companies allow an ASC to bill using ICD-10 procedure codes, just like any hospital. Currently, Medicare requires all ASC charges to be submitted electronically via the CMS-1500 form, while most other insurers use the UB92 form.
When reporting charges to Medicare, the modifier SG must be used to indicate that services were performed in an ASC. Other payers may wish to see the SG modifier to help differentiate between a facility’s charge and a physician’s bill. Always check with specific insurance companies to determine their Overview of ASC billing rules.
Points to Remember:
- The ASC pays for device-intensive processes, such as pacemaker insertion, but not as a separate line item.
- The cost of the device would be included in the procedure code and submitted as a single line item by the centre.
- Most ASCs are not allowed to base their prices on the allowed code on the Medicare Physician Fee Schedule.
Determination of Covered Procedures – CMS’s Regulations
When dealing with Medicare, centres must remember that not all processes permitted in a hospital setting are allowed in an ASC setting. To be “approved” by Medicare, a procedure must demonstrate that it does not represent a significant safety risk or need an overnight stay following the surgery. If you are unsure, call Medicare.
The following criteria are used to compile the list of approved procedures:
- They cannot be life-threatening or emergency procedures, such as a heart transplant or reattaching a severed limb.
- They cannot be performed safely in a physician’s office.
- They can be urgent or elective.
Common ASC Coding Errors
First, ensure that the ASC”s charges correspond to what was really performed in the form of services.
- One of the most prevalent coding errors is coding based on the headings of the procedure rather than the actual surgical report. Many ambulatory surgical centres and other freestanding outpatient clinics wisely wait for the whole surgeon’s report before billing for previously planned services, as the final report may contain fewer (or different) operations.
This will almost certainly result in denial once it reaches the payer. Thus, a coder should always read the complete operative report and investigate any differences.
- Misreporting open and arthroscopic methods as one surgery is another typical inaccuracy. This occurs when an arthroscopic operation is initiated and subsequently converted to an open procedure for any reason. Many coders incorrectly bill for both, while only the open process should be coded.
Note that this does not apply when the practitioner combines an arthroscopic operation with an open procedure. They can be invoiced separately as long as they are two distinct operations.
Benefits of Outsourcing ASC Billing & Coding
Though many freestanding surgery centres and similar facilities have their own in-house billing departments, more complex billing and reimbursement issues frequently necessitate the attention of skilled ASC billing specialists. In fact, understanding significant legislation changes to ASC billing standards can take time for your in-house billing team to comprehend and apply efficiently!
Outsourcing and partnering with a reliable ASC billing and coding company is one of the quickest and easiest ways to automatically adopt new billing and coding guidelines. Such outsourcing will give your office personnel more time to focus on providing the best service and care possible. Instead of spending hours on the phone trying to collect unpaid bills, an outsourcing ASC billing company may focus on growing the practice’s patient base and improving its healthcare experience to keep the patients it already has.