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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The Impact of Hospital Billing Processes on Patients’ Longer-Term Satisfaction

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The way that business offices can have reference patterns amongst consumers is a tactical opportunity as the insurance market moves to high deductible plans and hospitals take in new physicians into their business. According to a survey conducted by Connance in 2011 Americans who received hospital services in the past 2 years, merely 21% of patients engaged with the business office after discharge are completely contented with hospital billing, and those less happy are less liable to recommend the hospital to their friends and acquaintances.

Moreover, the survey also suggests that among the insured respondents, 31% had high deductible plans. Overall contentment with the hospital billing procedures is low with just twenty-one percent awarding billing processes a score “5” (on a 1 to 5 scale) and sixty-five percent giving a “3” or less. Customers with balances due of fewer than $100 are likely to be less unhappy, with thirty-six percent giving business office procedures a top score of “5” and forty-six percent a “3” or less. Among those with balances over $100, just fifteen percent scored the business office process a “5” whereas seventy-two percent rated it a “3” or less.

General contentment at discharge is high compared to satisfaction in later months. When asked to rate their satisfaction with the general hospital experience at the time of discharge, 32% are completely contented. When requested to rate their general approval with the hospital experience post-discharge and subsequent to business office processes, as mentioned earlier merely 21% percent are completely contented. The billing process has a definite impact on patient satisfaction and optimizing the process would not only increase the satisfaction of consumers but also positively affect the revenue.

A simple way of maintaining the quality of the billing process without high costs is outsourcing the process to professionals who have experience in this area. This would ensure that wastage due to a high insurance denial rate does not happen and that hospitals and clinics are paid the right amount at the right time. Medical billers and coders at medicalbillersandcoders.com play a crucial role in optimizing the revenue cycle management of hospitals and providers and thus contribute to a better patient experience and satisfaction.

To learn more about The Impact of Hospital Billing Processes on Patients’ Longer-Term Satisfaction, click here: https://bit.ly/45ajOGC  Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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