Why Are Medical Necessity Audits Increasing in the ASC Era?

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Medical necessity audits are increasing in the ASC era because payers are closely scrutinizing outpatient surgical procedures to control costs and prevent improper reimbursement. As more procedures shift to Ambulatory Surgery Centers (ASCs) , payers are tightening documentation standards and reviewing claims more aggressively. This shift directly impacts ASC billing , reimbursement timelines, and compliance risk. Understanding this trend is essential for protecting surgical revenue. What Is Driving the Rise in Medical Necessity Audits? The expansion of outpatient surgery has increased payer oversight. Procedures once performed in hospitals are now commonly done in ASCs, often at lower cost. Payers are responding with: Increased medical necessity audits Stricter pre-authorization requirements Targeted review of high-cost procedures Greater documentation scrutiny The goal is cost control, but the result is higher denial risk. How Do Medical Necessity Audits Impact ASC Revenu...
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ASC- The promising avenues for improving the delivery of health care

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ASCs, bring revolution in surgical care who led to the establishment of affordable and safe outpatient surgery. Moreover, The ASC industry is ahead of the curve in identifying avenues for improving the delivery of health care.

ASCs are a rare example of a successful transformation in healthcare delivery.

Hence stakeholders must understand about ASCs and their benefits and growth factors of ASCs:

  • What is ASC?

ASCs are modern healthcare facilities that offer patients the convenience of having surgeries and procedures performed safely outside the hospital setting.

The first ASC facility was opened in Phoenix by two physicians in 1970. These physicians saw an opportunity to establish a high-quality, cost-effective alternative to inpatient hospital care for surgical services.

  • Benefits of ASCs

Today, physicians are continually providing the impetus which helps in the development of new ASCs. Physicians have realized that they gain increased control over their surgical practices by operating in ASCs instead of hospitals.

Moreover, physicians can assemble teams of specially trained and highly skilled staff, schedule procedures more conveniently, ensure the best-suited equipment and supplies are being used to their techniques, and design facilities tailored to their specialties and to the specific.

  • Rising demand for ASCs

Rising demand for ASCs driven by demand from the key participants in surgical care including patients, physicians, and insurers, and technology made this demand possible. Moreover, high levels of patient satisfaction, efficient physician practice, high levels of quality, and cost savings are also contributing factors to the growth of ASCs.

  • Role of ASCs in outpatient surgical services

The growing range of procedures can be performed safely on an outpatient basis with the help of technological advancement. Outpatient migration is mainly driven by faster-acting and more effective anesthetics and less aggressive techniques, such as arthroscopy.

Only a few years ago some procedures which were needed major incisions, and long-acting anesthetics can now be performed through closed techniques with the help of short-acting anesthetics, and minimal recovery time. With the help of advanced medical innovations, more and more procedures will be able to be performed safely in the outpatient setting.

The ASC industry is ahead of the curve in identifying promising avenues for improving the delivery of health care.

Today, if we compare Medicare pays for hospitals and ASCs for the same services then.

ASCs are getting paid nearly 55% of the amount paid to hospital outpatient departments for performing the same services from Medicare.

To know more about the Ambulatory Surgical Centers (ASC) and their benefits and growth factors of ASC, click here: https://bit.ly/40y5dC1 Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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