Why Surgeon Coding and Facility Claims Must Match — The ASC Synchronization Problem Payers Are Now Auditing

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Ambulatory surgery centers (ASCs) are facing increasing pressure to keep professional and facility claims consistent. A surgeon may submit a professional claim for a procedure while the ASC submits a separate facility claim for the same encounter. Although these claims serve different billing purposes, the clinical details behind them should tell the same story. When surgeon coding and facility claims do not match, payers may see inconsistencies that can trigger claim reviews, payment delays, downcoding, or denials. The problem is not always an incorrect CPT code. Sometimes the issue is that two correctly prepared claims do not appear synchronized. The ASC Synchronization Problem ASC billing involves multiple parties. The surgeon or physician group submits the professional claim, while the facility submits the institutional claim for the services and resources provided by the ASC. Both claims can contain different codes because they represent different components of the same encounter....
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CMS announcement for durable medical equipment suppliers

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The Centers for Medicare and Medicaid Services (CMS) announced updated guidance regarding several emergency waivers identified with Medicare and Medicaid policies and regulatory updates during this pandemic for durable medical equipment suppliers. The CMS probably will continue to announce supplemental guidance on the sweeping waivers. 

Here we have a definite summary of the significant waivers that will influence durable medical equipment suppliers, prosthetics, orthotics, and supplies (DME) and are projected to set up the American healthcare system with maximum adaptability to respond to the public health emergency. These brief changes will remain as a result across the U.S. healthcare system for the duration of the pandemic emergency declaration. 

By enacting these waivers, CMS hopes to "put patients over paperwork" to give some relief from the vast documentation work, reporting, and audit requirements. Presently providers and regulators can focus on providing the required consideration to Medicare and Medicaid beneficiaries impacted by a coronavirus. 

Prior Authorization 

CMS waiving certain Medicare, Medicaid, and Youngsters' Health Insurance Program (CHIP) requirements to release the administrative head of consistency during public health emergencies. In ordinary conditions, DME suppliers are required to undergo a prior authorization process to ensure that the applicable coverage, payment, and medical coding rules are met before the durable medical equipment supplier delivers DME supplies to beneficiaries. 

According to CMS announcement, CMS is pausing this public prior-authorization program for certain DME suppliers to ease the administrative burden. 

Lost and Harmed DME 

On the off chance that DME is harmed or lost, DME Medicare Administrative Contractors presently have the privilege and adaptability to forgo certain substitution requirements, regularly such requirements are required by Medicare. According to CMS, for an eye to eye encounter, new medical required documentation, new physician orders, which ordinarily are required to support reimbursement for a substitution thing, are postponed during the public health emergency. 

Though CMS has loosened up this regulation it cautioned durable medical equipment suppliers that they should still include a story description on the case clarification why the durable medical equipment must be supplanted. This incident must be appropriately documenting the loss or harm of equipment. CMS announced this 'documentation waiver' retroactive to include 'Dates of Service' on or after Walk 1, 2020. 

Increase in DME Payment 

As it is essential by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, CMS will continue to regulate the fee schedule payments for equipment and services furnished in non-contiguous and rural, non-serious bidding areas based on a fifty-fifty mix of adjusted and unadjusted rates for the remainder of the coronavirus pandemic. 

Specifically, to durable medical equipment suppliers, CMS will give higher payment to certain durable medical equipment and services furnished in non-serious bidding areas within the contiguous United States with dates of service on or after Walk 6, 2020, through the remainder of the Coronavirus public health emergency as required by the CARES Act. 

CMS is presumably to announce supplementary guidance on these regulatory changes and Medical Billers and Coders will continue to screen coronavirus pandemic related developments and give updates. 

About Medical Billers and Coders 

We are catering to in excess of 40 specialties, Medical Billers and Coders (MBC) are capable in handling services that range from revenue cycle management to ICD-10 testing solutions. The main objective of our association is to assist physicians looking for billers and coders.

Location: 108 W 13th St, Wilmington, DE 19801, USA

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