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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Advantages of utilizing Orthopedic Billing Outsourcing Services

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Orthopedic billing is a vital interaction of any orthopedic practice. To keep your practice moving along as planned by limiting claim denials and cash flow issues, It is imperative to remember a couple of perspectives while billing: 

  • Double-check patient information, 
  • Verify insurance coverage, 
  • Use the right code and 
  • File your claims quickly. 

How Does Orthopedic Billing Work? 

Orthopedic billing starts with legitimate documentation previously, during, and after a patient's visit. It's critical to give appropriate consideration to coding during the full degree of services. Why? 

  • One, for boosting reimbursement and limiting claim denials and 
  • Second, for year-end administration cost analysis

Advantages of utilizing Orthopedic Billing Outsourcing Services: 

  • Outsourcing your billing to Orthopedic Billing professionals with the experience and information on perplexities of orthopedics eases all your efforts required for updating your staff and systems. These professionals have the required information on the mind-boggling rules used via carriers to adjudicate claims and the ever-changing CPT codes and associated modifiers applied to ensure proper reimbursements. 
  • With certified medical coders and Orthopedic specialized billers, these billing services can assist you with distinguishing billing problems and denied claims. The professionals evaluate the underpayments and submit claims appeals with correct documentation. The bill appropriately utilizing correct ICD, CPT, and modifier codes, ensuring maximum reimbursement. 
  • Outsourcing billing services help in reducing the overall cost of regular training and education of the staff, ensuring the staff focuses on the tasks they are more experienced and comfortable at, and providing valuable care to the local area. 
  • Since all the information and coding of all the charges are correctly processed at the very first time, reimbursements are fast and your practice gains the added advantage of lower than industry average accounts receivable balances. 
  • Apart from that, these trained and experienced professionals track each claim carefully until the payments are received. They do the required A/R circle back to payers and patients. 

Outsourcing your orthopedic billing services can actually increase your net revenue and ensure that you receive the maximum amount covered by the insurance companies while limiting any cash-based costs for your patients. 

It's important to be sure that the company you hire understands the orthopedic specialty while getting you every dollar you deserve!

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