Why Are Medical Necessity Audits Increasing in the ASC Era?

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Medical necessity audits are increasing in the ASC era because payers are closely scrutinizing outpatient surgical procedures to control costs and prevent improper reimbursement. As more procedures shift to Ambulatory Surgery Centers (ASCs) , payers are tightening documentation standards and reviewing claims more aggressively. This shift directly impacts ASC billing , reimbursement timelines, and compliance risk. Understanding this trend is essential for protecting surgical revenue. What Is Driving the Rise in Medical Necessity Audits? The expansion of outpatient surgery has increased payer oversight. Procedures once performed in hospitals are now commonly done in ASCs, often at lower cost. Payers are responding with: Increased medical necessity audits Stricter pre-authorization requirements Targeted review of high-cost procedures Greater documentation scrutiny The goal is cost control, but the result is higher denial risk. How Do Medical Necessity Audits Impact ASC Revenu...
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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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