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 Outpatient Surgery Center Coding and Billing Tips

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Healthcare reforms and services are driving the change in the way the medical industry, including hospitals, healthcare centers, ambulatory surgical centers, and medical coding and billing services work. As medicinal reforms cause variance in repayment rates, doctors and physicians more or less are shifting towards in-house hospital jobs to provide quality, financially affordable care, which most of the ASCs do offer but with some hindrances. In this blog, Here our medical billing and coding experts shared 4 outpatient surgery center coding and billing tips.

Here are 4 Outpatient Surgery Center Coding and Billing Tips.

1. Conduct Sporadic Coding Reviews.

It is critical to direct and conduct periodic coding reviews by an outside coding organization, whether your center outsources its coding benefits or utilizes an ensured coder. That way you can wipe out the conflicting situation a customary coding institute might have in discovering coding mistakes in the belief of increasing extra clientele. All authorized centers should hold a satisfactory standard above 90 percent precision, however, allowed to disprove coding mistakes found amid a review.

Remember that a sound coding practice is to dependably code from the operative report and not from the procedure.

2. Utilize Modifiers that Oblige to meet Payer Rules.

Certain bearers have distinctive preferences with regard to modifiers, and coders must know which carriers prefer which modifiers before they present a case. Modifier predispositions can contrast via carrier and by state, so coders need to do their assessment to keep away from denied claims.

If coders are uninformed of a carrier’s favored modifier, they can contact the page and examine how the case should be submitted. Once the center sees a dissent, the A/R rep ought to have the capacity to recognize what caused the denial and let the coder know the bearer’s favored modifier.

3. Identify the Electronic Pathway of case Entries to each Payer.

Outpatient billing managers should chart out a way of electronic claim submission of each payer. Electronic cases are sent from providers to the provider’s EDI organization and, at times, to a few trading partners before the case comes to the payer—the more extended path the case takes; there more opportunities for errors.

For instance, an ASC might utilize an EDI association that does not have an immediate contract with a specific payer. If that is the situation, the EDI Company would send the case to a trading partner which could conceivably have an immediate contract with the payer. Then again if the trading partner does not have an immediate contract, the case would go to yet another accomplice before coming to the payer. Knowing the pathway of cases can likewise give medical billing agencies a better idea as to what extent cases will take to reach payers.

To know more about the 4 Outpatient Surgery Center Coding and Billing Tips, click here: https://bit.ly/3ORbTYL Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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