Ambulatory Surgical Centers-Progressive Model for Surgical Services

Ambulatory Surgical Centers (ASC) one of the fastest-growing medical services today that offers patients the opportunity to have selected surgical and procedural services performed outside the hospital setting. Physicians have contributed to the development of ASCs and they have the opportunity to directly control their surgical practices if they operate in ASCs as compared to hospitals. ASC settings offer various benefits to the physicians such as physicians can schedule procedures more conveniently, assemble teams of specially-trained and highly skilled staff, ensure the equipment and supplies being used are best suited to their technique and design facilities tailored to their specialties.

 ASCs improve Physician’s efficiency

The aging population is one of the major drivers for significant growth in the demand for surgical services as well as the attendant need for surgical subspecialists. These rising surgical needs can be fulfilled with the help of increasing the number of surgical residency positions, increasing the workloads of surgeons in the workforce, and improving the efficiency of surgeons. ASCs offer physicians the ability to work more efficiently and play an important role in managing the increased need for surgical services soon.

The ASC health care delivery model allows physicians

  • To focus exclusively on a small number of processes in a single setting as compared to hospital settings that have large-scale demands for space, and resources.
  • To enhance quality control processes as ASCs are focused on a smaller space and a small number of operating rooms
  • To allow physicians to personally guide innovative strategies for governance, leadership, and quality initiatives.

Unlike physicians, surgeons, or hospital billing, there are some things that the billing department must know before filing a claim for services rendered through an ASC.

ASC billing and coding

ASC uses a combination of physician and hospital billing also it employing the CPT and HCPCS level codes and some insurance carriers permit an ASC to bill using ICD-10 procedure codes like hospitals. Currently, Medicare needs to fill all ASC charges electronically using the CMS-1500 form. Moreover, Medicare requires the use of modifier SG to indicate that services were performed from an ASC while submitting charges. Other payers also prefer to see the SG modifier to help distinguish between the facility’s bill and that of a physician

Common ASC coding errors

The most common coding errors include coding based on a procedure’s headings instead of the actual surgical report as procedures are noted in the final report are fewer or different. This mistake resulted in claim denial once it reaches the payer, hence a coder should thoroughly read the entire operative report and avoid such mistakes.

Another common error is misreporting open and arthroscopic techniques as one procedure. This error occurs mostly when a procedure is started arthroscopically then converted to an open procedure. Many coders mistakenly bill for both however only the open procedure is the correct procedure to be coded for claims

While most of the freestanding surgical centers have their dedicated billing departments however, complicated billing and reimbursement queries often require the experienced billing professionals to solve. We at Medical Billers and Coders (MBC) are helping practices of all sizes and specialties to improve their billing accuracy and reimbursement rates.