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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Shortage of General Surgeons and its Effect on Hospital Revenue

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The acute shortage of general surgeons is evident in the Occupational Outlook Handbook of the Bureau of Labor Statistics which states that only 5% of physicians were general surgeons in the year 2007, and the situation has not improved since. In fact, the shortage of general surgeons is getting worse and is projected to worsen in the future. The role of a general surgeon cannot be underestimated in a country where the population is increasing and millions more are receiving health insurance due to the reforms. The population of the country is estimated to grow by more than 30 million by the year 2020 and the country’s baby boomer population and the population of old people would be very high. This would certainly put humungous pressure on general surgeons and have manifold consequences for general surgeons as well as for the health industry. A hospital revenue bond is a type of municipal bond that finances the construction of new facilities or upgrades for existing hospitals.

The problems of general surgeons don’t just stop at the shortage and the endless work hours but extend to many challenges that are unique to this specialty. In rural areas as well there is a higher shortage of general surgeons. An article in the Archives of Surgery called The Increasing Workload of General Surgery gives some facts about the future of this specialty. According to the article, the workload of general surgeons will increase by 31.5% between 2000 and 2020 with the amount of workload growth varying among the five different types of surgeries that are taken into account from 19.9% to 40.3%. Hospital revenue is the money that a medical center generates from operations.

We apply our General Surgery Billing and Coding Services to Improve Coding Guidelines and Reduce Denials.

This increasing workload is affecting hospital emergency rooms the hardest since most surgeries are performed in bigger hospitals and also due to the fact that general surgeons usually determine whether or not to operate on a patient in emergency rooms. This increased demand and shortened supply of general surgeons would not only cause detrimental health consequences for the general populace in the future but also cause huge financial damage to almost all entities involved in the healthcare system.

To learn more about the Shortage of General Surgeons and its Effect on Hospital Revenue, click here: https://bit.ly/3J72rx4 Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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