Understanding ASC Billing Challenges

July 13, 2016

../../images/articles/Understanding ASC Billing Challenges.jpg

With advancement in medical facilities across the nation, the United States now hosts almost the same number of Ambulatory Surgical Centers as there are Hospitals. Though the numbers of outpatient surgeries are gaining popularity day by day, physicians, coders and insurance companies have to keep changing their daily proceedings with changes in the norms of Health care reforms. Insurance does play a comparable part in outpatient procedures they would play generally, however they are normally faster to act and the expenses connected with the procedures are lower. Claim denials for ASCs and lesser reimbursements put profits at a risk.

An insight into the ASC billing challenges will enable a smooth workflow, aiding in avoiding occurrence of issues cropping in receiving complete reimbursement.

Industry Highlights-

If a patient fails to pay within 28 days, the chances of getting paid at all reduce to below 10 percent.
States with the highest denial rates for surgery centers-
  • New York – 37 percent
  • Georgia – 27 percent
  • Kentucky – 22 percent
  • Kansas – 21 percent
  • Indiana – 19 percent
  • Alabama – 8 percent

  • Issue with the payer's structure for claims
    In case your ASC facility is facing persistent denials from the same payer for reasons that seem unclear, there could be chances of an issue with the payers' structure of the system. An analysis of the situation can give help with information to bolster the pattern and directly confront the payer. Since they will not proactively take steps to make amendments, it is necessary to reach out to them before your ASC faces any more denials.
  • Lack of documentation
    Despite submitting all the required documentation, payers may still deem necessary extra documentation, which could be a plausible strategy by the payers to slow down the process of paying the Ambulatory Surgical Center.
  • CMS reimbursements
    ASCs experience a 2 percent decrease in annual payment if their quality statistics that is reported is not according to the Ambulatory Surgical Center Quality Reporting Program guidelines. It is mandatory for ASCs to meet 11 required and one voluntary measure, else be subjected to the reduction applied to CMS reimbursement in 2018.

Professional and certified coders can ensure strategies for effective coding. An analysis of the errors and challenges that keep ASCs from getting properly reimbursed is important as this will help in the long run to avoid these. Ensuring the ASC facility maintains profits at the same time can successfully tend to the patients with quality care is an important aspect.


Category : Best Billing and Coding Practices