Avoiding Medicare Audits for Your ASC Billing Practice

For both outpatient and inpatient administrations, ASC billing services comprise billing of cases established for treatments performed by physicians, suppliers, and other non-institutional suppliers.

But when it comes to your ASC Billing Practice, you already know that the only thing worse than having to maintain and follow are complicated Medicare’s set of rules is having to worry about a prospective audit. Internalizing the system’s insurance regulations and multiple restrictions is required when treating Medicare patients. This may be rather be overwhelming at times and the continuous pressure of an audit doesn’t help to calm your nerves.

However, ASC’s billing services are not always error-free and it can arise for a variety of reasons, including incorrect codes, a lack of monitoring, inconsistency in billing methods, failure to adhere to professional standards, and breaking out services and billing as separate procedures when they should be included.

With that in mind, here’s a quick review of everything you need to know about Medicare audits and how to avoid them. Although avoiding a Medicare audit may be impossible, following these tips can help ensure that you are well prepared.

Detail Documentation

To minimize Medicare audits, proper and complete billing documentation is required for Ambulatory Surgery Center (ASC) services. It’s critical to have a solid understanding of what Medicare considers reasonable and essential when it comes to chargeable services. This refrains you from filing a false claim that could result in an audit by avoiding unbundling for example, charging separately for consultation, dressings, or hot packs or even up-coding that is, billing for a service that is more expensive than the one that was really given.

Accurate Documentation

While the use of templates is acceptable sometimes, the paperwork must be extensive, precise and tailored to each individual patient to avoid any sort of copy-pasting. The date and time of surgery, as well as the execution of an advanced beneficiary notification for non-covered services, must be noted in order to avoid any misinformation. In case any illegible signatures, stamping signatures, or failing to provide accurate information is witnessed then the chances of a Medicare audit increases significantly.


Using the services of a qualified coder to conduct a performance audit might help you identify possible issues. Even if it’s just done once a year, it might help your ASC Billing Practice identify areas where you’d benefit from additional training and more importantly, coding audits on a regular basis successfully show your efforts to code appropriately. In case you are in a situation where you are confronted with concerns about your honesty, this substantially can aid your case. Regular audits demonstrate that billing and coding errors are not made on purpose and rather it’s an error.

E&M Coding

According to statistics, physicians who over-code for evaluation and management services are at a considerably higher risk of being audited. Regularly reviewing coding patterns and staying updated can help you avoid making this mistake. Knowing where you stand out in your coding patterns might help you take the necessary actions to solve the problem, whether through extra information or through the assistance of a trained coder.


Modifiers have been an important part of the Medicare billing process since the implementation of Physician Payment Reform in 1992. Correctly applying modifiers can assist assure payment for services that might otherwise be refused if not for the modifier indicated. Additionally, reporting several services without the appropriate modifier can generate suspicions of unbundling by the ASC provider. Modifiers when utilized correctly, can help you avoid a Medicare audit while also raising revenue for your ASC services.


For any ASC Billing Practice, a Medicare audit can be an unwanted and unpleasant experience. While it is best to avoid it entirely, this is not always possible. As a result, it’s vital for surgery centers to stay on top of Medicare coding standards and guidelines, maintain track of denied claims, and keep an eye on audit focus areas that the contractors publish on a regular basis. You must also keep track of previous audit findings and endeavour to avoid Medicare audits in the future.

Wondering how you can do everything on your own? Well, you don’t have to. You can simply Outsource Ambulatory Service Center billing to 24/7 Medical Billing Services which can take care of all your billing needs. Our most competent professionals and certified coders ensure that your billing system is constantly up to date with Medicare regulations while maintaining accurate and detailed documentation so that your practice doesn’t need to face Medicare audits. Our in-depth knowledge and expertise in using codes enable us to maintain your ASC medical record system for consistency in medical coding and billing processes. Just drop us an email at info@247medicalbillingservices.com or call us on +1 888-502-0537 to know how we do what we do- saving the pain of Medicare audits.

Read more: Difference Between ASC & Hospital Billing Services

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