The Ambulatory Surgical Center (ASC) as a healthcare service market has grown rapidly in recent years. As insurance limitations get more stringent and health costs increasing by the day, more and more people are now turning to the outpatient facilities for quality surgery at affordable rates. Outsourcing your ASC medical billing and coding helps you with many of the financial fears and increases profitability. But, recent reports indicate that even though ASCs continue to become the fastest growing healthcare service, there are many challenges when it comes to improving revenue performance.
For an outpatient surgery center to bill services, it must qualify and meet the requirements laid down by the Centers for Medicare and Medicaid Services (CMS). Remember that ASCs are either independent physician-owned or they are associated with a hospital or medical center.
Payment procedure of Ambulatory Surgical Centers
For ASC to get reimbursed the service provided has to be a medically necessity. The medical procedure performed need to meet certain requirements decided by both the patient and the provider.
Does ASC require any specialty billing?
Ambulatory surgery service charging typically does not focus on a specific medical specialty, also it does not revolve around particular procedures, services, and diagnoses. So, billing is unlike any medical specialty billing. But, ASC medical billing uses the same techniques, codes, and guidelines as other medical entities. For example, ASC bills use CMS-1500 claim forms, while hospitals use UB-04 claim forms for reimbursement.
What type of services get covered?
Depending on the status of the medical facility the ASC guidelines for covered services are charted out. When an ASC is fully credentialed, it is able to perform numerous procedures, thus making it the fastest growing healthcare service.
Services not covered in ASC are:
- Non-implantable durable medical equipment
- Artificial arm, leg, and eyes
- Physician services
- Independent laboratory services
- Ambulance services
- Leg, back, neck, and arm braces
- Prosthetic devices
Are procedural codes different?
As far as medical billing for ASC is concerned, the procedural codes must be precise in order for efficient and sufficient reimbursement. These codes change according to the procedures being performed and the kind of medical facility where services are provided. The two vital codes used here are the ICD-10-PCS, which covers inpatient procedures, and the Current Procedural Terminology (CPT) that gives information regarding services rendered. These are applied along with ICD-10 diagnosis codes.
Multiple specialties point towards a variety of underlying causes, diagnoses, and procedures. Keep in mind that charging for ASC multi-specialty procedures is complicated, but it is one of the fastest growing healthcare services. To function efficiently, the billing personnel should be knowledgeable in charging and coding, filing claims, manage customer service, and also perform payment posting. Along with this, A/R follow-up has to be done, which comprises denial management.