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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Medical billing to assist Primary Care Physicians in streamlining their practice

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The lack of primary care providers in the country is a topic that has been hotly debated among many circles and written about vehemently. Not many medical students are ready to enter primary care due to a lack of great financial prospects for the future. This is resulting in even more shortage of physicians and problems when it comes to the reputation of this line of medicine. The remuneration problems along with other difficulties faced by Primary Care Physicians (PCPs) are affecting the revenue of PCPs and bringing a disparity between other physicians who practice other specialties of medicine. Here are numerous reasons for the reimbursement disparities for PCPs and some possible solutions for countering this problem.

One of the reasons for the lesser amount of remuneration for PCPs is that specialists who perform routine procedures such as some specific types of surgeries take a lesser amount of time to complete their task compared to a PCP whose case can be of any nature. Another explanation for the comparatively lesser amount of pay of PCPs is that the majority of these are either solo practitioners or work in a small group whereas specialists like surgeons and cardiologists have a chance to work in a big hospital with even bigger pecuniary benefits.

Browse: Primary Care Medical Billing

There are many problems that are synonymous with the problems of PCPs and of those faced by solo practices. The burden of supervising all the functions of a small practice along with carrying out the core aspects of medicine is also a hurdle that hampers efficient time and financial management. Moreover, the Medicare rates given to PCPs are causing resentment among PCPs where a group of people has filed a suit against Medicare regarding their low reimbursement rates to Primary Care Physicians. Medicare cuts are another problem faced by especially PCPs since they are responsible for treating a large number of elderly patients and act as an entry point for specialties if any particular problem is diagnosed, which is usually a possibility in elderly patients.

The health reforms have provided a glimmer of hope for PCPs due to many policies that have been implemented. However, compliance with these policies is also a challenge that is faced by physicians and providers along with PCPs. The incentives provided by the government for the implementation of EMR and EHR systems can be a definite financial advantage, especially for PCPs. However, streamlining all the departmental processes to implement this cutting-edge technology is perhaps the most important prerequisite for qualifying for the incentives through ‘Meaningful Use’.

To learn more about Medical billing to assist Primary Care Physicians in streamlining their practice, click here: https://bit.ly/42aJujE  Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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