7 Frequently asked ASC Billing Questions



Ambulatory Surgical Centers (ASCs) cater to patients who need medically essential surgeries but do not require an overnight stay at a hospital. Following are certain frequently asked questions in the ASCs billing and coding arena:

1. Which is the top information systems management for ASCs?

A couple of models used for ASCs are: Electronic billing and a strong reporting package, ASP model for supporting business competence, data analysis using excel, immediate insurance verification, scanning of reports into patients’ charts, software compatibility, facility billing, and ASP model for business competency. Types of A/R reports that ASC software programs can generate are insurance provider, financial class, date, patient and procedure.

2. What is the standard for A/R days outstanding?

A/R is the money owed by a patient to ASC for services provided (short-term asset). Due to a difference in the case of each patient along with different insurance providers, market location, and out-of-network volume (increases A/R days), there is no ideal number for A/R. It is imperative to benchmark against other centers to stay on the top.

3. When is the time to switch to outsourcing?

If the staff is not technically skilled and talented, if cash metrics does not meet the national criterion and outdated technology is affecting business, it is time to switch to outsourcing.

4. What are the things to buy while switching from paper to electronic?

First determine if the return on investment will prop up the switch. Following this, choose Electronic Health Records (EHRs) or Electronic Medical Records (EMRs). EHR is less expensive; however, time, money and cost outlay decides which system you want to buy along with reviewing the features of both. EHRs store the clinical and financial data of ASCs while EMRs store data, allow data sharing, and encompass physician dictation section. Both of these should also be able to interface with other systems of the ASC center.

5. What is required for reporting the -TC modifier?

The -TC modifier should be reported only when the ASCs bill for facility charges (with HCPCS codes) and have a technical and professional constituent under the Medicare Physician Fee Schedule (MPFS).

6. Which are the paid procedures and services in ASCs?

The billable procedures are mentioned in Addendum AA of the hospital outpatient prospective payment system (OPPS)/ASC final rule. ASCs can bill separately for certain ancillary services that are covered by Medicare such as brachytherapy, certain implantable items, drugs, biologicals and radiology services etc. Physician examinations and prosthetic devices can be billed under Medicare Part B.

7. Do ASCs get reimbursed for devices categorized as pass-through devices?

Pass-through devices are those that give substantial relief to patients. These are paid separately for two to three years (at contracted price rates which are an important part of a covered surgical procedure and sometimes the reduction applies only when same code services are provided by the same provider on the same day).

ASC billing and coding needs to be tackled well with all parameters in place, for ensuring full reimbursement and higher profitability.

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