Understand Payment Rates and Basics of ASC Billing

-

 

understandpaymentratesandbasicsofascbilling.jpg

 

Basics of ASC Billing

An Ambulatory Surgical Center (ASC) is defined by CMS as a facility with the sole purpose of providing outpatient surgical services to patients. ASC is a facility that, very simply, specializes in outpatient procedures. Procedures done at an ASC are more extensive than those done at the typical provider’s office but are not so involved that they require a hospital stay. The basics of ASC billing (Ambulatory Surgery Center) are completely different than any other type of billing. For ASC services to be paid, the service must be determined to be medically necessary. Generally, there are two primary elements in the total cost of performing a surgical procedure:

  • The cost of the physician’s professional services for performing the procedure
  • The cost of services furnished by the facility where the procedure is performed (for example, surgical supplies and equipment, and nursing services).

In general, the Medicare program pays ASCs 80 percent of the lesser of the actual charge or the ASC facility payment rate for the covered services performed. The beneficiary pays 20 percent of the lesser of the submitted charge or the ASC facility payment rate for the covered services performed. Payment rates for most services are geographically adjusted using the pre-reclassification wage index values that CMS uses to pay non-acute providers. The adjustment for geographic wage variation will be made based on a 50 percent labor-related share.

Ambulatory surgical center claims are filed to Medicare, Medicare Advantage Plans, and Medicaid on an HCFA 1500 or the 837P. This is different from hospital outpatient surgery claims to the payers, which are filed on the UB-04 or the 837I. The CMS-1500 is the red-ink on white paper standard claim form used by physicians and suppliers for claim billing.

To know more about the Payment Rates and Basics of ASC Billing click here: http://bit.ly/3y8auny Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

Comments

Post a Comment

Popular posts from this blog

What are the most common mistakes In-House people make with medical bills?

-
Image
Let's be honest, medical bills can tangle anyone's brain, even those working inside hospitals and clinics! Folks like doctors' office assistants and hospital staff handle internal billing daily, but even they can stumble into common mistakes that leave patients grumpy and paperwork piled high. Let's shine a light on these hiccups and equip you with some simple tips to navigate the world of bills with ease, making everyone's day a little brighter! 1.        Blind Trust in Automation: Automating billing processes streamlines workflow, but relying solely on technology can be a trap. Errors can slip through the cracks, leading to inaccurate bills and unhappy patients. 2.        Misunderstanding Insurance Lingo: Medical jargon and insurance codes can feel like a foreign language. In-house staff who aren't familiar with the nuances can interpret coverage incorrectly, leading to mismatched bills and frustrated patients. 3....
Read more

Understanding 8-Minute Rule for Therapists

-
Image
  Introduction The therapy 8-minute rule is a vital concept for therapists, specifically in the context of billing Medicare or Medicaid for their services. This rule allows therapists to calculate the appropriate number of billable units based on the duration of direct contact therapeutic services provided to a patient. Understanding the 8-minute rule is essential to avoid billing errors, delays in reimbursement, audits, and underbilling. In this article, we will delve into the intricacies of the therapy 8-minute rule, its application in therapy billing, and how to calculate billable units accurately. What is the Therapy 8-Minute Rule? The therapy 8-minute rule refers to the method used by therapists, including occupational therapists, physical therapists, and speech therapists, to determine the number of billable units for Medicare or Medicaid reimbursement. It applies to timed services where therapists provide one-on-one sessions with patients for at least eight minutes. Sin...
Read more

Why does your Staff Fail to Collect Revenue from Patients?

-
Image
  After 25 years of training medical practice staff how to successfully ask patients to pay at the point of service, there are many common excuses that we hear when staff members fail to collect Revenue from Patients. As per the Consumer Financial Protection Bureau (CFPB) report released in December 2014, 43 million citizens have overdue medical debt and a staggering 52 % of all debt on credit reports is from  medical billing . The findings of the study clearly indicate that patient collection is becoming a  serious threat to the profitability of the provider’s office. Factors like ongoing economic instability combined with the implementation of the Affordable Health Care Act and the shift in payment models to be consumer-direct with high deductibles have all consolidated into greater difficulties for the provider’s office at revenue collection from patients. Reasons Your Staff Fails to Collect Revenue from Patients To elaborate, here are a few reasons why provider’s ...
Read more