Ambulatory Surgical CentersRevenue Cycle Management (RCM)

Why you May Not are Receiving Reimbursement for ASC Medical Billing?

ASC medical billing widely known as Ambulatory Surgery Centre is different from the rest of the billing process. Before you go forward, it’s important to know what ASC is all about.

Ambulatory Surgery Centre is a facility which simply specializes in outpatient procedures which may include procedures like surgeries, pain management, or diagnosing procedure like colonoscopies, etc. Usually, the procedure performed at ASC is extensive than the typical ones; also they might require an overnight stay at a hospital.

ASC is not a medical specialty….it doesn’t revolve around specific services, diagnosis, or procedures. ASC billing and coding uses all same codes, billing techniques, and many of the same billing and coding guidelines by the entire medical industry.

Hospitals use the UB-04 claim form, doctor’s offices and other outpatient healthcare providers to use the CMS-1500 form. In this case, ASCs are no different and use the typical provider form.

Ambulatory Service Centres are like having every medical specialty all rolled into one.

You can go there for a cast, a colonoscopy, or for surgical dressings. But, you can’t go there for a sick visit and get a diagnosis from a primary care physician. ASCs only provide services to those who already have a diagnosis from a primary care physician, and who need medically necessary procedures performed.

Knowing ASC Billing and Coding

ASC billing uses a combination of hospital and physician billing. However; ASCs use CPT and HCPCS Level II codes to bill most of their services, some payers will allow an ASC to bill ICD-9-CM procedure codes like the hospital. Some payers even base implant reimbursement on revenue code classification.

It’s important to use the proper form when submitting claims. Medicare pays for ASC services under Part B and requires the CMS-1500 claim form. Some third-party carriers will accept the CMS-1500 form, while others allow the UB04. To avoid errors in ASC medical billing it is advisable to hire outsourced ASC billing services.

ASC requires focused billing and coding. Below mentioned are significant things to know in which you may not be receiving reimbursement for ASC medical billing:

You may lose your money if your codes are not in the right order

Once you have referenced the operative report and you know which codes to bill for, it’s essential to put your codes in the right order. Make sure you record your codes from the highest reimbursement to the lowest reimbursement so that you don’t lose money unnecessarily. It may be possible to correct your reimbursement if you make this mistake, but it is recommends doing it right the first time to save yourself a lot of hassle.

Medicare will not reimburse for those treated in a skilled nursing facility

ASCs that have previously treated patients from skilled nursing facilities will most likely be subject to reimbursement take-backs for procedures that occurred since Jan. 1, 2008. While there’s nothing ASCs can do to combat this decision, you should still prepare yourself for the setbacks by identifying your skilled nursing facility patients.

HIPAA-exempt carriers who don’t use standard codes

Your ASC should be aware of carriers who don’t follow standardized coding practices because of HIPAA exemption. Worker’s compensation carriers, small carriers, and other carriers that are HIPAA-exempt can come up with home-grown codes, and you’re not going to get paid if you use standardized codes.

 To avoid having your claims rejected, make sure you know whether your carrier is exempt.

Your managed care contract is important

Your biller should have a copy of every managed care contract and you need to understand how long you have to submit a claim, how long you have to review an adjudicated claim, what the payment methodology is, why a carrier would reduce multiple procedures, and how to appeal a claim that hasn’t been paid correctly.

Your ASC should use your managed care contract to bill out, post payments, and follow up, and you need it at every point of the revenue cycle.

ASC physicians can’t afford for codes to be entered incorrectly or incompetently. They can’t afford delays in payment or financial uncertainty. ASC physicians must make sure they’re reimbursed for every dollar they are owed in a timely fashion; hence outsourcing to ASC billing company Ohio can help from financial fallout.

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