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

-
Image
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....
Post a Comment

Coding Guidelines for Coronavirus for Medicare Beneficiaries

-

In the 2nd seven-day stretch of Walk 2020, Congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act. The legislation will permit physicians and other health care professionals to charge Medicare expense for-administration for understanding care conveyed by telehealth during the current coronavirus public health emergency. What's going on in the private health insurance sector stays muddled and may change from payer to payer. CMS likewise gave a fact sheet on 'Information Identified with COVID–19 Individual and Little Gathering Business sector Insurance Coverage.' 

  1. CMS has made two-Healthcare Common Procedure Coding System (HCPCS) codes to report testing for coronavirus. Labs that test patients for the new coronavirus utilizing the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real-Time RT-PCR Diagnostic Test Panel may charge for that test utilizing the new HCPCS code (U0001). This code is utilized explicitly for CDC testing laboratories to test patients for SARS-CoV-2. 
  2. The second HCPCS charging code (U0002) permits laboratories to charge for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). On Feb. 29, 2020, the Food and Drug Administration (FDA) gave another, smoothed-out approach for certain laboratories to build up their own approved COVID-19 tests. 
  3. This second HCPCS code might be utilized for tests created by these extra laboratories when submitting cases to Medicare or health insurers. Diagnosis coding for coronavirus is likewise accessible. 
  4. For a diagnosis of COVID-19, report the code for the patient condition that is identified with the COVID-19 (e.g., J12.89, "Other viral pneumonia") and B97.29, "Other coronavirus as the reason for diseases grouped somewhere else." 
  5. For suspected COVID-19, not affirmed or ruled out at the experience, report codes for the introducing signs and symptoms. Try not to report a code for coronavirus when this diagnosis isn't expressed in the clinical record. 
  6. For known openness to COVID-19 (without a diagnosis of COVID-19), report Z20.828, "Contact with and (suspected) openness to other viral, communicable diseases." 
  7. For suspected openness to COVID-19 that is ruled out after assessment, report Z03.818, "Experience for perception for suspected openness to other biological agents ruled out." 

For more information, if it's not too much trouble, see CMS's habitually posed inquiries for health care providers regarding Medicare payment for laboratory tests and different administrations identified with the 2019 novel coronavirus. CMS has likewise given related fact sheets pertaining to Medicare and Medicaid and the Kids's Health Insurance Program. Coverage, payment, and different parts of getting paid for administrations identified with the coronavirus are consistently developing. Stay tuned to the MBC web journals for further updates.

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

Comments

Post a Comment

Popular posts from this blog

Is Your Neurology Billing Outsourcing Helping or Hurting You at Year-End?

-
Image
  As year-end approaches, neurology practices face a crucial decision: Is your billing outsourcing truly improving your financial performance, or silently affecting your revenue? Neurology billing is complex due to time-based coding, modifier usage, high documentation requirements, frequent audits, and prior authorization challenges. If your billing partner lacks neurology-specific expertise, it may lead to claim denials, revenue loss, and compliance risks. Signs Your Neurology Billing Outsourcing Is Helping If your billing partner is performing well, you will see: • Reduced denial rates for neurology codes (EEG, EMG, Botox, Nerve Conduction Studies) • Faster reimbursements and fewer delays from payers • Active recovery of old AR beyond 60, 90, or 120+ days • Accurate CPT, ICD-10, and modifier usage for neurology procedures • Clear billing reports, denial analysis, and revenue insights • Compliance with Medicare, commercial payers, and documentation standards Warning ...
Read more

How Hidden OB-GYN Billing Errors Are Quietly Costing You Millions Each Year

-
Image
  The Silent Revenue Leak in OB-GYN Practices Most OB-GYN practices don’t realize they’re bleeding money. Not in dramatic, headline-grabbing ways, but quietly, steadily, month after month. The phones are ringing, appointment slots are full, deliveries are happening, and yet the numbers never seem to match the effort. Sound familiar? This is often the first sign of hidden OB-GYN billing errors working behind the scenes. These errors don’t announce themselves. They don’t crash your systems or send angry alerts. Instead, they slip through claims, hide in coding nuances, and quietly shave thousands—or millions—off your annual revenue. OB-GYN billing is uniquely complex compared to other specialties. Between global maternity packages, split billing scenarios, high-risk pregnancy coding, and ever-changing payer rules, the margin for error is enormous. A single missed modifier or incorrectly bundled service might seem insignificant on its own. But when repeated across hundreds or thousand...
Read more

The #1 Reason ASCs Lose Revenue from Medicare Claims (And How to Fix It)

-
Image
Ambulatory Surgical Centers don’t lose Medicare revenue because of low case volume. They lose it because of one recurring, preventable failure: Incorrect coding and documentation for Medicare’s ASC-specific payment rules. This single issue triggers denials, underpayments, delayed reimbursement, and permanent write-offs — especially at year-end. If your ASC’s Medicare revenue feels unpredictable, this is why. The #1 Revenue Killer: Not Billing Medicare the “ASC Way” Medicare does not treat ASCs like hospitals or physician offices. Yet many ASCs still: Use hospital-style assumptions Miss ASC-only payment rules Underestimate Medicare’s bundling logic The result? Claims get paid less than expected — or not at all. Where Medicare ASC Claims Go Wrong 1. Incorrect CPT eligibility for ASC payment Not every CPT code is payable in an ASC setting under Medicare. Common mistakes: Billing procedures not on Medicare’s ASC approved list Assuming “covered in hospital” = “covered in ASC” Missing annual...
Read more