Medical Billing and the Ambulatory Surgery Center: Key Points

Although medical billing is subject to quite a bit of generalization across the entire healthcare spectrum, different billing environments call for different requirements. Take the ambulatory surgery center (ASC). It is a very different environment compared to a GP's office.

 

ASC medical billing is even somewhat unique within the hospital environment. This is largely due to the specialized nature of surgical procedures. It takes quite a bit of experience and some specific knowledge to master medical billing in an ASC.

 

If you are thinking of taking your medical billing skills to the ASC environment, here are some key points to consider:

 

 

By design, ASCs specialize in outpatient procedures. Patients come in, undergo their respective surgeries, and head home the same day. By contrast, more complex surgical procedures require longer hospitalization. Billers are faced with accounting for a much longer stay and more clinician encounters, medications, etc.

 

The longer a patient is hospitalized, the more complicated medical billing becomes. By contrast, ASC medical billing is comparatively easier because patients are in and out on the same day.

 

 

Among the benefits ASC medical billing offers experienced billers transitioning from other environments is use of the familiar CPT and HCPCS Level II codes for procedures and services. The codes are similar to those used in traditional physician billing. However, there may be cases for utilizing ICD-10 codes that aren't normally utilized in outpatient settings.

 

When it comes to supplies and drugs built to Medicare, ASCs typically do not use C-Codes. Instead, each billed item needs to be reported separately. This one particular issue can make ASC billing a bit more difficult.

 

 

ASCs participating in Medicare must be cognizant of the fact that their reimbursements go through their own unique prospective payment system (PPS). In addition, reimbursements are subject to ambulatory payment classifications (APCs). Unlike other situations in which a patient's entire encounter is considered for billing purposes, APCs group similar procedures into categories which are subjected to predetermined reimbursement amounts.

 

 

ASC medical billing is subject to the same challenges as billing in any other environment. The potential for coding errors is near the top of the list for consideration. Due to the unique ASC environment, proper training of everyone involved – this includes clinicians, coders, and billers – is the key to keeping mistakes to a minimum.

 

Other challenges include:

The one thing that stands out in the ASC environment is the potential for a slow reimbursement process. Medical coders and billers need to be at the top of their game to keep revenue streams flowing without having to worry about billing deadlines.

 

 

Staying ahead to ensure swift and timely reimbursement requires having a handle on the ASC billing process. Obviously, ASCs bill both private insurance companies and Medicare/Medicaid. There are cases when ASCs bill patients directly.

 

When claims are sent to insurance payers, they are filed electronically. CMS-1500 is utilized for Medicare while the UB-04 is for all other claims. Accurate coding and documentation are a necessity, regardless. To minimize errors prior to claim processing, ASCs often rely on claim scrubbing.

 

ASC medical billing can be fairly complex despite the fact that procedures are patient-only. Some ASCs outsource to private medical billers rather than looking to hire biller encoders with the right expertise. At any rate, ASCs rely on competent and skilled billers to guarantee accurate billing and timely reimbursement. Without both, revenues are in jeopardy.