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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General Surgery Medical Coding Steps to Avoid Denials

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Physicians in general surgery are facing an uphill task of medical billing keeping in check the different needs of the facilities and keeping a tab on the effective revenue cycle management to look for frequent denials and which of the claims need more efficient coding. The channel of insurance payment has been one of the most straining factors for general surgery physicians today affecting the bottom line of the revenue and in turn affecting the facility.  Individual physicians have the high cost of staffing and also revenue management which has led to many of them being absorbed by groups acquired by the hospital. General Surgery is one such facility that has seen a rise in individual costs and most of the facilities are either in the group or combined with hospitals.

Tracking different types of patient care from appointment scheduling to registration and different steps for collection of the balance fall under the revenue cycle management. The healthcare revenue cycle is a financial system that has brought in the work of administrative and clinical functions associated with billing. The process happens to take into consideration different data points which are coded into a format that helps the understanding of an insurance company. These codes are usually laid by the Center for Medicare and Medicaid Service (CMS) and also the price value of each procedure or diagnostic is decided beforehand to help cover the cost and also a margin of profit for the doctors.

If you want to read the complete blog then click below: General Surgery Medical Coding Steps to Avoid Denials


Location: Louisiana, USA

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