Ambulatory surgical centers (ASCs facility) uniquely provide outpatient healthcare to the US population. By providing specialized services outside the hospital setting, ASCs allow patients greater access, a higher level of convenience, and more focused and cost-effective care when undergoing procedures that do not require overnight stays.
Billing for services performed in an ASC is similar to a hospital, where the physician submits one bill for professional services, and the hospital or ASC submits a separate bill to cover the costs of the facility. In comparison, procedural services performed in the office setting are reimbursed by Medicare and several insurers with an additional site-of-service differential calculated into the payment to cover the physician’s expenses related to staff, equipment, and overhead to provide the service.
Coding for Ambulatory Surgery Centers is a specialty unto itself. It is a facility service, but Medicare requires ASC’s to send their bills to the professional fee – Part B payers but using the facility fee Part A claim form.
There is a whole different set of regulations and bundling edits to use for ASCs. Many ASCs use the same codes as the surgeons, but that can be a revenue “kiss of death” and create compliance exposure for every shareholder-or-partner in the ASC.
The rules of the game are different for ASCs than for surgeons or for hospitals; at times ASCs must follow the rules for doctors, and at other times they must adhere to the hospital’s rules. A simple modifier used incorrectly can deliver a “fatal blow” to an otherwise clean claim for thousands of dollars.
Many ASCs are partially owned and managed by national ASC development and management companies. We code for quite a few, offering them a consistent level of coding accuracy and responsiveness across all of their locations. Some of their ASCs are located in smaller cities and communities that don’t have deep labor pools for experienced ASC coders. With HIPAA-compliant document management and remote access to electronic medical records, we can code for those ASCs as easily as if we were at the next desk.
ASC Coding Need
- Well-trained ambulatory surgical center coders are hard to find.
- Few ambulatory surgery center coders are certified, and few certified coders have ambulatory surgery center experience.
- Ambulatory surgery center coding guidelines are complex, change often, and are different than those for physicians; codes and modifiers that work for physicians are not always acceptable for ambulatory surgery centers.
- Coder turnover, vacations, and family leave create cash flow peaks and valleys.
- With so few coders specializing in this niche, it is difficult to find and hire experienced ambulatory surgery coders, even in large metropolitan areas. ASC’s in smaller communities and tight labor markets have trouble filling openings.
- The wide range of specialties represented at ASC is beyond most coders’ capabilities.
ASC Coding Services
- Ongoing ambulatory surgical center coding coverage for all or part of your caseload
- Temporary ambulatory surgical center coding coverage for vacations and sick leave
- Second opinion coding services
- Backlog coding resolution services
- Compliance “peer” reviews
- Physician documentation training
- Physician documentation deficiency reporting
- ASC Coding “helpline” services
- OIG and RAC audit defense
An ambulatory surgical center (ASC) is a healthcare facility that is dedicated to providing medically necessary surgical services to a patient in the outpatient setting. ASCs are paid according to a unique set of regulations and standards under the Medicare program, under Medicaid, and under contractual agreements with private commercial health insurers.
Professional medical billers are conversant with the applicable regulations and contractual obligations that govern the reimbursement of services provided by ASCs. As with the rest of the healthcare industry, new covered procedures are added and deleted on a regular basis, as well as the services that are considered a part of the surgical package.
As experts in the financial aspects of healthcare delivery, professional medical billers provide advice on which services can and cannot be provided by an ASC. They do this in conjunction with certified medical coders, who advise on the documentation requirements needed to report specifically covered HCPCS codes to make sure procedures are being performed in the appropriate venue.
FAQs
1. How is billing handled for services performed in an ASC compared to a hospital or office setting?
- Billing in ASCs involves separate bills for professional services and facility costs, similar to hospitals. In contrast, procedural services performed in an office setting may include an additional site-of-service differential to cover physician expenses, including staff and equipment.
2. What makes coding for ASCs different from other healthcare settings?
- ASC coding is unique due to Medicare’s requirement for ASCs to submit bills to professional fee (Part B) payers using the facility fee (Part A) claim form. ASCs must also adhere to different regulations and bundling edits, which can create compliance challenges if not handled correctly.
3. Why is it challenging to find experienced coders specifically for ASCs?
- Certified coders with ASC experience are scarce, as ASC coding guidelines differ from those for physicians and require specialized knowledge. Additionally, coder turnover and a limited labor pool make it especially difficult for ASCs in smaller communities to hire skilled ASC coders.
4. What services do ASC coding experts offer to support compliance and efficiency?
- ASC coding experts provide services like ongoing coding coverage, backlog resolution, compliance reviews, second opinion coding, and training for physician documentation. They also assist with audit defense and offer a helpline for coding-related questions.
5. How do professional billers and coders help ASCs stay compliant with changing regulations?
- Professional billers and coders stay updated on ASC-specific regulations under Medicare, Medicaid, and private insurers, helping ASCs understand which services are reimbursable and ensuring accurate documentation for covered HCPCS codes. Their expertise helps maintain compliance and optimize revenue.
