03 Jan Overview of Medical Billing for Ambulatory Surgery Centers
An ambulatory surgery center (ASC) is a medical facility that specializes in outpatient procedures. Both diagnostic and therapeutic procedures are performed by the healthcare workers at the ambulatory surgical center.
In order for a medical facility to bill for services, it must qualify by meeting requirements by the Centers for Medicare and Medicaid Services (CMS). ASCs are either independent physician-owned, or they are affiliated with a hospital or medical center.
How are Ambulatory Surgical Centers Paid?
In order for ASC services to be paid, the service provided has to be medically necessary. The medical procedure performed must meet certain requirements decided upon by both the patient and the provider.
What form is used to Bill for ASC Services?
Ambulatory service center billing is not focused on a specific medical specialty, and it does not revolve around particular procedures, services, or diagnoses. This means that the billing is unlike medical specialty billing. However, ASC billing uses the same techniques, codes, and guidelines as other medical entities. An ASC bills using CMS-1500 claim forms, whereas hospitals use UB-04 claim forms.
What Services are Covered?
What is covered under ASC guidelines depends on the status of the medical facility. When a facility is fully credentialed, it is able to perform many procedures. Services not covered include:
- Independent laboratory services
- Ambulance services
- Leg, back, neck, and arm braces
- Non-implantable durable medical equipment
- Artificial arm, leg, and eyes
- Physician services
- Prosthetic devices
How are the Procedural Codes Different?
Regarding medical billing for ASC, the procedural codes must be accurate in order for efficient and adequate reimbursement. These codes change according to which procedures are being performed and the type of medical facility where services are provided. The two codes used are the ICD-10-PCS, which covers inpatient procedures, and the Current Procedural Terminology (CPT), which provides information regarding services rendered. These are used along with ICD-10 diagnosis codes.
What is Involved in Day-to-Day ASC Billing?
- Code all causes, with a focus on compliance, accuracy, and quick turn-a-round
- Verify that every procedure is billed
- Enter charges immediately and accurately
- Submit claims to carriers electronically
- Submit secondary claims
- Work on denials and unacceptable payments
- Post all patient and insurance payments, time of service payments, adjustments, and co-pays
- Maintain a toll-free number for client and patient inquiries
- Provide up to date monthly statistics that detail case volumes, financial data, and trends
What about ASC Multi-Specialty Billing?
Multiple specialties means a variety of underlying causes, diagnoses, and procedures. Billing for ASC multi-specialty procedures is complicated. To function efficiently, the billing staff should be knowledgeable in charging posts, coding, filing claims, customer service, and payment posting. In addition, A/R follow-up has to be done, which includes denial management.
Why Outsource Medical Billing?
There are numerous benefits to outsourcing your ASC billing. The main benefits include:
- Cost effectiveness – No employee or clerical expenses, as well as no turnover, training, or HR issues.
- Efficiency – Well-trained staff will focus on claims submissions and correct coding.
- Effectiveness – Proper tracking and follow-up on claims submitted, as well as improved collections tracking.
- Controllable – Costs do not vary, and accountability is well defined.
MPMR offers elite medical billing services for ambulatory surgery centers. In addition to the billing and coding services, Medical Practice Management Resources also can offer operational help to further increase efficiencies and revenue!