5 Critical Things to Know About ASC Billing

An ambulatory surgical center (ASC) uses a unique billing process. It is different from what physicians, surgeons, or hospitals use.

Whether you’re new to ASC billing or improving an existing process, there are things you should know about it to ensure compliance with filing requirements while avoiding costly delays and errors. Consider ASC billing services to eliminate the guesswork and improve your likelihood of complete and faster reimbursement.

1. How ASCs are defined based on CMS guidelines

According to the Medicare Carriers Manual, an ASC is a distinct and separate institution that provides outpatient surgical services and treatment. Based on these rules and for Medicare purposes, a hospital-run facility may either be an ASC or a provider-based department in the hospital. But, as CMS pushes for cost reduction, newer trends are shifting to the ‘bedless hospital’ concept for most services (such as same-day surgeries). These centers are redefining ambulatory care.

2. ASC billing and coding

ASC billing combines hospital or clinical and physician billing using HCPCS and CPT level codes. Some insurance providers allow ASC coding with ICD-10 procedure codes. Procedures involving devices (such as pacemaker insertion) pay the ASC for the device. As such, the center must include the cost of the device in the procedure code and submit it as a single line item. Currently, Medicare requires electronically filed ASC charges using the CMS-1500 form. Other insurers use the UB92 form.

3. Regulations for determining covered procedures

Medicare cannot cover all procedures. For approval, CMS determined that a given procedure must not pose a significant safety risk or require an overnight admission later.

4. Common coding errors

One of the most common errors in ASC coding is based on the headings of a procedure instead of the surgical report. ASC billing services will ensure the ASC charges match the procedure. Coders thoroughly explore the whole operative report and question discrepancies to avoid denials.

Another standard error is misreporting arthroscopic and open techniques as a single procedure. This usually happens when a procedure gets initiated arthroscopically and later becomes an open procedure. Some coders will bill for both when only the open procedure must be coded.

5. It’s wise to leave ASC billing and coding to experts

You can avoid ASC billing errors, coding discrepancies, and denials by outsourcing to a reputable medical billing company. Established ASC billing services offer innovative RCM solutions to increase efficiency.

About the Author:

Thomas John leads a global team of 500 employees in 3 locations as the President & CEO of Plutus Health providing, RPA powered revenue cycle management services to healthcare organizations across 22 states. Plutus Health Inc. is a 15-year-old full-cycle RCM firm specializing in medical coding & billing, denial management, credentialing, prior authorizations, AR follow-up for both medical and behavioral health specialties. As the industry experts in revenue cycle management solutions, they've created a unique process that combines machine learning and robotic process automation to address the clients' most frustrating problems.

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