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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Prominent Ambulatory Surgery Center Medical Billing Functions are Affecting Your Practice Revenue

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Compliance guidelines that govern the Ambulatory Surgery Center’s reimbursement are wide-ranging, complex, and ever-changing. Hence, it’s important for ASCs to hire or partner with Ambulatory Surgery Center medical billing and coding management consultants who understand the legal rules placed on ASCs, including specialized coding, accreditation, documentation, and reimbursement care contracts.

Here are Prominent Ambulatory Surgery Center Medical Billing Functions are Affecting Your Practice Revenue

The Rise in the Number of Accounts Receivable (AR) Days

AR basically refers to the average number of days that an ASC takes to collect payments for the services provided. Days in AR are one of the main methods that ASCs use to measure their financial performance. The factors impacting the AR days are procedure scheduling, patient pre-registration, insurance verification, patient financial counseling, patient payment plans, and patient collections. An important tip here would be setting up a patient financing solution that pays within just a few days of the service provided which can reduce days in A/R.

Surgery Cancellations

Surgery cancellations have always been a major cause of concern for ASCs. Facing high out-of-pocket costs for a certain surgery, many patients whose surgery is canceled, may not rearrange as they think that would incur more expense. Same-day cancellations of a scheduled surgery have a tangible, negative impact on your facility’s bottom line. Another suggested strategy is implementing patient financing options. Providing a secured loan to patients to cover their surgical costs can reduce cancellations, grow surgery numbers, lower AR days, and increase cash flow.

To know more about the Prominent Ambulatory Surgery Center Medical Billing Functions are Affecting Your Practice Revenue, click here: https://bit.ly/3Uksqpn Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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