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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4 Common Misconceptions about Ambulatory Surgical Centers (ASC)

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Ambulatory Surgical Centers or ASCs as it is commonly called were first established in Phoenix, Arizona in 1970 by two physicians who wanted to provide comfortable care to the people in their community so that they could avoid more impersonal venues like hospitals. Slowly over the years with Medicare approving payments to ASCs they have gained prominence and in some cases are scoring over the normal hospitals for certain procedures.

The fact that ASCs provide a high-quality yet cost-effective alternative to the inpatient care provided at hospitals has seen a surge in outpatient centers. Hospitals grappling with scheduling delays, slow operating room turnover, and budget cuts which have impacted the purchase of new medical equipment, coupled with other operational issues that have prompted patients to visit ASCs to receive care.

Industry Snippet

The revenue of the ASC is slated at $28 billion with an expected growth rate of over 5 percent between the years 2010– 015. ASCs are said to have a low level of market share concentration. A case in point being the four largest market players will generate less than 12 percent of the total revenue. However, over the next few years, it is expected that the industry will consolidate with many large ASCs taking over the smaller ones and forging associations with other healthcare providers.

Demystifying 4 Common Misconceptions about Ambulatory Surgical Centers

Ambulatory Surgical Centers and hospitals are not different entities

People should realize that ASCs and hospitals are two different entities. It is not necessary that the kind of facilities that hospitals have ASCs might have them too. Of course, patient care should not be compromised but it would be incorrect to expect the same treatment at an ASC as a hospital.

ASCs can help in getting surgery done cheaply

This is one of the sad misconceptions where people feel that if one needs to get a procedure done cheaply they can avoid a hospital and go to an ASC. However, one needs to remember that ASCs get the same Medicare certification and other accreditations that a hospital needs to get and the motive for ASC is to provide high-quality care at a lower cost compared to a hospital but it is by no means cheap as they have standards to uphold.

ASCs suit everyone

To learn more about The 4 Common Misconceptions about Ambulatory Surgical Centers (ASC), click here: https://bit.ly/3qJ0zBM  Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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