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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Enhance Pathology Revenue with a Smooth Billing Process

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The constant change in the healthcare industry has impacted timely reimbursement for medical practices over the past few years. Pathology Medicare and Medicaid have gone on a reduction spree as far as physician reimbursements are concerned. Most third-party payers like Cigna and Aetna are keener on signing up contracts with physicians that focus on fee-for-service, where the reimbursement is less than 100% more often than not.

Here are a few ways to enhance revenues and have a perfect billing process in place.

Be Familiar with your LCDs

Pathology billing companies need to be familiar with Local Coverage Determinations (LCDs) and know the ins and outs of how they are related to various specialties and other frequently billed services. LCDs give a crystal clear picture of the instances when some procedures are covered by Pathology Medicare. They will also indicate the specific circumstances under which a procedure is considered appropriate and absolutely necessary. One can also find details on coding guidelines that facilitate reimbursement faster and without any hitches. 

Be thorough with your Electronic submission reports

Submission reports can come in very handy for a Pathology Billing Services provider while verifying various claims that are submitted. They can easily track the claims received by the payers. The reports also help keep track of the rejected claims and know about the reasons why they were rejected. Pathology billing companies can intensely review such reports to ward off probable denials, make necessary corrections and resubmit the claims immediately. Claims that did not reach the payers can also be investigated and scanned for errors, which can be corrected before resubmission.

To know more about our Pathology Billing Process click here: https://bit.ly/3V9TBDf Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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