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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Internal Medicine Practices Handling A Unique Billing Process Gain From Specialized Medical Billing

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Medical billing can be challenging for all types of medical practices; however, for internal medicine physicians/internists, it can be even trickier as the billing procedure for them is quite unique. Internal Medicine Practices is a medical practice providing healthcare services for adult patients

Why is Billing Unique for Internists?

  • For the majority of medical conditions, patients first go to internal medicine practitioners for diagnosis and basic treatment. From there they are referred to specialists for further medical care if required. Due to this, internists become dependent on other practices or practitioners for payment and the billing process gets complicated
  • Internal medicine practitioners offer diverse services. They see approximately 30-40 patients on a daily basis. Besides hospitals and nursing homes, they also visit patients at offices and homes. Due to a high number of patients, they need to handle a large volume of claims which creates a greater possibility for errors and denials
  • As internists need to collaborate with multiple practitioners and deal with various patients, regular changes in coding also complicate the billing process

Hence Internists prefer outsourcing billing and coding services to a billing partner so that minor mistakes such as negligence in procedure billing, under-coding office visits, or errors in coding do not hamper their chances of getting paid what they deserve.

Since the billing partner will be entirely focused on filing claims, following up with insurance companies, and handling claim denials, it saves money and time for Internal Medicine Billing practices which can be used on patient care.

To learn more about Internal Medicine Practices Handling A Unique Billing Process Gain From Specialized Medical Billing, click here: https://bit.ly/3WICklH Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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