The total healthcare expenditure has seen an exponential increase in recent years. Seeing this growth, the Centers for Medicare and Medicaid Services initiated new programs and payment systems that can help reduce overall costs while enabling physicians and healthcare providers to offer cost-effective care to their patients. Over the years, the healthcare infrastructure has also seen an increase in outpatient procedures that were conducted in ambulatory surgical centers (ASCs). ASCs exclusively provide outpatient surgeries which are a same-day or 24hour stay, typically focusing on a small subcategory of regular procedures and treatments. This approach allows ASC to reduce the overall costs of surgery and those linked with post-operative care while allowing healthcare providers to receive similar outcomes and ensure quality patient satisfaction.
Since the Affordable Care Act, reimbursements in ASCs have reduced approximately to 42% as compared to hospitals for the same procedure. This has reduced the growth and extensive use of ASCs. In spite of these changes, the ASC sector still witnessed an increase in revenue by $24 billion with an annual growth rate of 5%.
This welcomed a financial opportunity for many large practices, healthcare providers, and hospital systems in recent years.
Here are a few trends in ASC Services that you should know
- Ambulatory Service Center billing is not actually centered on a specific medical specialty which means it doesn’t involve any specific types of procedures or diagnoses. Therefore, Ambulatory Surgery Center billing is completely different from any other type of physician or facility billing. Unlike other medical specialty billing, ASC billing companies do not require learning highly specialized guidelines or rules to ensure reimbursement for services.
- For ASC billing services, you will first have to qualify by adhering to a certain set of requirements and also have a written agreement with CMS. In order to pay for ASC services, the service must be stated as medically necessary but the medical procedure doesn’t have to be performed at an ASC as well. This call is completely given to both the provider and the patient.
- Usually, ASC billing uses similar codes, regulations, billing systems, and many of the same billing and coding guidelines used by the medical industry. But what makes it so different is that its codes are done through a CMS-1500 claim form, not a facility claim form, unlike hospital billing that uses the UB-04 claim form while the practitioners and remaining outpatient providers use the CMS-1500 form. Think of Ambulatory Service Centers like a medical specialty combined into one. Outsource ambulatory surgical center medical billing services to stay updated with the latest regulations.
- With respect to the Total Knee Arthroplasty which became a part of the Medicare ASC-payable list for 2020, Medicare has assigned a specific code to it. It is called the “device-intensive indicator”. This will not offer any separate reimbursement for the implants utilized in the Total Knee Arthroplasty, Medicare will ensure it adds a portion of the device along with the complex TKA Medicare reimbursement charges.
- While working with bundled payments for claims processes, it is recommended to work alongside providers to negotiate the terms of the contract. This can help receive a confirmation on whether one claim will include the professional, anesthesia, and surgery free while discussing the payment distribution as per documentation that is operationally efficient and comes with lesser billing complexities. It is a complex task since the payers wish to have all the services within the same claim and handling this might need some assistance. Hence outsourcing ASC billing services can be a good option.
- Billing procedures for ambulatory surgical centers depend on the type of facility chosen and the location of treatment. Payment for ASC services is based on HMSA’s eligible charge. This eligible charge for a covered service is one all-inclusive rate based on the highest Outpatient Surgical Procedure-Related Group category of the procedure code billed.
Why outsource ASC billing?
Outsource Ambulatory Service Center billing service to 24/7 Medical Billing Services to receive the most professional and certified team who ensures your billing system is always following the latest trends of the industry. ASC can be complex and we at 24/7 Medical Billing Services would like to simplify it for you so that you can focus on your services while we handle your billing system.