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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5 Benefits of Outsourcing ASC Billing

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Ambulatory Surgical Centers (ASCs’) are very busy places with a constant influx of patients; hence additional administrative tasks can be time-consuming. With ASCs’, there may be challenging times when deadlines are short and compliance regulations are stringent, so managing billing can be a costly affair in ways more than one. Therefore, outsourcing may seem to be an effective option for Ambulatory Surgical Centers. Outsourcing ASC billing can be beneficial in many ways as listed.

Furthermore, there are a lot of aspects that need to be taken care of when billing. Any negligence can cause a loss of revenue. The in–house team may or may not be able to cope with the changing regulations resulting in the submission of incorrect bills. Moreover, the ASC teams’ primary role would be to attend to the patients and the simultaneous billing could seem like an added stress.

Industry Snippet

The ASC industry is pegged at 28 billion dollars with an annual growth rate of 4%. It is employing more than 270,000 people and AmSurg is one of the pioneers in this space.

ASCs are a cost-effective way of carrying out immediate surgeries and have an improved quality of patient care. They provide a cost-effective alternative to hospitals that are grappling with scheduling delays, the paucity of operating room facilities, etc. In the coming years, the industry is expected to grow owing to health reforms.

5 Key Benefits of Outsourcing ASC Billing are Mentioned Below:

  • Billing companies are adept in dealing with payers and in case of errors of any kind, can be skillfully handled by them with a thorough follow-up.
  • Overhead costs of hiring a billing team and handling the ensuing staff issues can take away a lot of time and money from the practice and in this case, outsourcing can help in reducing the costs of hiring your own team.

To know more about the 5 Benefits of Outsourcing ASC Billing, click here: https://bit.ly/3p6ZZzw Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

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