The beginning of the Patient Protection and Affordable Care Act resulted in millions of Americans becoming insured on plans with out-of-network benefits. Also, this act has narrowed insurance networks which left many providers completely out-of-network. Therefore, the out-of-network strategy for ASC is only revenue revenue-enhancing strategy for some ASCs. There are some key opportunities available […]
Key Opportunities in out-of-network Strategy for ASC
Read More.. Key Opportunities in out-of-network Strategy for ASC
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 healthcare delivery. Hence stakeholders must understand about ASCs and […]
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 […]
Understanding ASC Billing and Coding
Starting January 1, 2008, the Centers for Medicare & Medicaid Services (CMS) revised the procedures eligible for ASC payment annually. Furthermore, CMS issued quarterly updates to the lists of covered surgical procedures and ancillary services to set payment indicators and rates for newly introduced Level II HCPCS and Category III CPT Codes pertaining to ASC […]
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. Medicare defines the ASC facility’s Global Period to be 24 […]
ASCs vs HOPDs – Understanding Payment Difference
ASCs vs HOPDs: When performing outpatient procedures, many orthopedic surgeons operate in either ASCs 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 a […]
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 service 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 […]
Basics of Medicare Payment for Ambulatory Surgical Services (ASCs)
Medicare covers surgical procedures provided in freestanding or hospital-operated ambulatory surgical services 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 […]
Ambulatory Surgical Center Terminated Procedures
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 […]
Understand Payment Rates and Basics of ASC Billing
Basics of ASC Billing The Basics of ASC billing encompass the financial processes associated with Ambulatory Surgical Centers (ASCs). CMS defines an Ambulatory Surgical Center (ASC) as a facility that provides outpatient surgical services to patients. ASC is a facility that, very simply, specializes in outpatient procedures. Procedures at an ASC are more extensive than […]
