ASC – The promising avenues for improving the delivery of health care

ASCs, bring revolution in surgical care who led to the establishment of affordable and safe outpatient surgery. Moreover, The ASC industry is ahead of the curve in identifying avenues for improving the delivery of health care. ASCs are a rare example of a successful transformation in health care delivery. Hence stakeholders must understand about ASCs […]


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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 […]


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Understanding ASC Coding and Billing

Beginning January 1, 2008, the CMS publishes updates to the list of procedures for which an ASC may be paid each year. In addition, CMS publishes quarterly updates to the lists of covered surgical procedures and covered ancillary services to establish payment indicators and payment rates for newly created Level II HCPCS and Category III […]


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Correct Use of Modifier 50 in ASC Billing

Modifiers are two-digit symbols added to CPT procedure codes to signify the procedure has been altered in some way. Modifiers are accepted by Medicare and most other payers, however, using modifiers correctly can be confusing, since not all payers want modifiers used the same way. Not using Modifiers according to each payer’s specifications can cause […]


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ASCs vs HOPDs – Understanding Payment Difference

When performing outpatient procedures, many orthopedic surgeons operate in either an ambulatory surgery center (ASC) or a hospital-based outpatient department (HOPD). Although some of the workflows and services offered may appear similar between the two, the background operations are substantially different from business and regulatory perspectives. An HOPD is owned by and typically attached to […]


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Deciphering 2021 CPT Code Changes for ASC

The American Medical Association (AMA) announced the release of the 2021 Current Procedural Terminology (CPT®) code set containing identifiers and descriptors assigned to each medical, surgical, and diagnostic services available to patients. Trusted since 1966 as the health system’s common language, the CPT code set enables accurate reporting, measurement, analysis, and benchmarking of medical services […]


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Basics of Medicare Payment for Ambulatory Surgical Services (ASCs)

Medicare covers surgical procedures provided in freestanding or hospital-operated ambulatory surgical centers (ASCs). In January 2008, Medicare began paying for facility services provided in ASCs— such as nursing, recovery care, anesthetics, drugs, and other supplies—using a new payment system that is primarily linked to the hospital outpatient prospective payment system (OPPS). (Medicare pays for the […]


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Ambulatory Surgical Center Terminated Procedures

The following guidance determines the appropriate ambulatory surgical center (ASC) facility payment for a scheduled surgical procedure that is terminated due to medical complications, which increase the surgical risk to the patient. Payment is denied when an ASC submits a claim for a procedure that is terminated before the patient is taken into the treatment […]


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Modifier 50 Fact Sheet

Modifier 50 applies to bilateral procedures performed on both sides of the body during the same operative session. When a procedure is identified by the terminology as bilateral or unilateral, the 50 modifiers are not reported. If a procedure is authorized for the 150 percent payment adjustment for bilateral procedures (payment policy indicator 1), the […]


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Understand Payment Rates and Basics of ASC Billing

An Ambulatory Surgical Center (ASC) is defined by CMS as a facility with the sole purpose of providing outpatient surgical services to patients. ASC is a facility that, very simply, specializes in outpatient procedures. Procedures done at an ASC are more extensive than those done at the typical provider’s office but are not so involved […]


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