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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Basic Billing Tips for New Medical Practice Start-ups

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You were putting up your own medical practice! This means you have probably done your research on the pros and cons, and are aware of the benefits and risks factors. The crucial question now is how to deal with the one and only daunting task – Medical Billing. To be able to maintain that balancing act of funding your practice and continuing to provide quality patient care, an effective practice management cycle is essential. For a successful Revenue Cycle Optimization, given that each component is interdependent right from eligibility checking, charge coding, and claims reimbursement, to accounts receivable and denial management, the state-of-the-art approach is required. Here are 5 essential billing tips that can help you get started to avoid the pitfalls in your new venture:

Basic Billing Tips for New Medical Practice Start-ups

1. Be informed: Your clinical and administrative staff should be trained to collect all insurance details from the patient before the patient–physician engagement is initiated. This includes the name of the insurance provider and the patient’s policy number.

2. Confirm: Your office staff should always confirm the kind of services that the insurance covers for the patient and what disease or ailment  the insurance coverage is for, thus avoiding later misgivings and the high rate of denial of claim reimbursements that may follow

3. Keep updated: With the economic challenges that the world is facing, and new health plans rolling out every year, rules keep changing. It is necessary that you know the fine print when dealing with insurance-covered patients so that claim reimbursements are high and the process of denial management is kept at abeyance

4. Automate: What most physicians have now realized is that automation of the Medical billing cycle is the key to transforming the physician revenue cycle, increasing efficiency, and decreasing claim denials. When you automate, denied claims can be easily routed through to the specialists, thus decreasing the wait time and increasing claim reimbursements much quicker than via the manual route of back and forth, causing unnecessary burdens on your staff.

5. Partner: The real key to building a successful revenue organization is Outsourcing. When you outsource your medical billing services via practice management vendors who can double up as clearing house vendors, the physician can concentrate on the core challenge- quality patient care, rather than on the cumbersome administrative process for medical billing. The reason is simple, the vendors can handle changes in software updates more easily, are updated about the intricacies involved in various kinds of insurance coverage, can verify details much more easily through their networks, are more aware of financial policies, insurance policies, compliance requirements, coding standards, and billing technology and can immediately fix the errors, thereby decreasing the waiting time for claim reimbursements.

To learn more about the Basic Billing Tips for New Medical Practice Start-ups, click here: https://bit.ly/3RqPkMe, Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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