Medical Billers and Coders

  Ambulatory billing refers to the process of generating and submitting accurate claims for services rendered at ambulatory surgery centers. In the rapidly evolving landscape of healthcare, ambulatory surgery centers (ASCs) have gained significant prominence as a cost-effective and efficient alternative to traditional hospital-based care. As the demand for ASCs continues to grow, it becomes crucial for ambulatory owners to optimize their revenue cycle management processes, particularly ambulatory surgical center billing. This blog aims to shed light on the importance of  Ambulatory Surgical Center Billing  and the benefits of outsourcing these services to a reliable medical billing company like  Medical Billers and Coders (MBC) . Understanding Ambulatory Billing  It involves coding procedures, documenting medical necessity, verifying insurance coverage, and ensuring compliance with regulatory guidelines. A well-executed ambulatory billing process is essenti...

  Care delivered by Ambulatory Surgical Centers (ASC) is more cost-effective compared to Hospital Outpatient Departments (HOPD) as it saves $2.6 billion a year for Medicare. However, the reimbursement rates for ASCs have been shrinking over the last decade, posing survival challenges for providers. On average, they are reimbursed 58% less compared to a hospital for a similar procedure. It has become important for the ASCs to identify and measure their revenue cycle key performance indicators ( KPI ) for ensuring financial success considering the shrinking reimbursement rate. According to industry experts, it is necessary to make sure that ASCs thrive financially because they play an essential role in providing high-quality, affordable care to patients. Have you Measured the KPIs yet? Is your revenue cycle being managed efficiently? Have you identified the KPIs of your revenue cycle such as net collection ratio and the AR aged above 90 days? If the answer is no, you need to sta...

  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 in...

  Same-day surgery now constitutes more than half the surgeries performed across America. Any surgical methodology performed without a healthcare office inpatient affirmation and an overnight stay is considered an outpatient surgery framework, whether they happen in a specialist facility, a physician’s clinic, or an outpatient surgery center. There are various obstinacies behind this development in the surgical zone. Outpatient surgeries are less immoderate than those performed on an inpatient premise and innovative advances have made outpatient surgeries more secure. Outpatient procedures, once compelled to astoundingly minor surgeries, for instance, cataract removals, now consolidate methodology as varied as facelifts, tonsillectomies, colonoscopies also pacemaker inserts. Alongside this  Ambulatory Surgical center billing and coding  maintenance has enhanced the utilization of ASCs, more than conventional social healthcare establishments. Here are the top 3 Ambulator...

  Ambulatory Surgical Centers (ASCs) cater to patients who need medically essential surgeries but do not require an overnight stay at a hospital. The following are certain frequently asked ASC Billing Questions arena: 7 Frequently Asked ASC Billing Questions 1. Which is the top information systems management for ASCs? A couple of models used for ASCs are Electronic billing and a strong reporting package, the ASP model for supporting business competence, data analysis using Excel, immediate insurance verification, scanning of reports into patients’ charts, software compatibility, facility billing, and the ASP model for business competency. Types of A/R reports that ASC software programs can generate are insurance provider, financial class, date, patient, and procedure. 2. What is the standard for A/R days outstanding? A/R is the money owed by a patient to ASC for services provided (short-term asset). Due to a difference in the case of each patient along with different insuran...

  Introduction to MBC as a Leading ASC Billing Company Medical Billers and Coders (MBC) is a leading ASC billing company that specializes in providing comprehensive billing services to ambulatory surgery centers (ASCs) across the United States. With over 20 years of experience in the healthcare industry, MBC has developed a reputation for delivering high-quality billing services that help ASCs maximize revenue and reduce denials. MBC’s team of certified coders and billing specialists work closely with healthcare providers and practices to develop customized billing solutions that meet their unique needs. MBC’s comprehensive billing services cover the entire billing cycle, from claims submission and follow-up to payment posting and reconciliation. MBC’s team of experts uses advanced technology and software to automate many of these processes, ensuring accuracy and efficiency. MBC also offers denial management services, identifying the root cause of claim denials and working with...

  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...

  Ever since their inception, Ambulatory surgery centers (ASCs), have been providing improved quality and customer service to the healthcare industry.  ASCs offer patients the opportunity to have selected surgical and procedural services performed outside the hospital setting.  ASC Centers  perform more than 7 million procedures for Medicare beneficiaries needing same-day surgical, diagnostic, and preventive procedures. Multisite practices operate nearly 26 percent of ASCs and the remaining 74 percent are stated to be independently owned. Because ASCs perform specific services and do so more efficiently, Medicare reimburses ASCs as a percentage of the amount paid to HOPDs, and pays ASC centers 53 percent of HOPD rates. A review of commercial medical claims data found that U.S. healthcare costs are reduced by more than $38 billion per year due to the availability of ASCs as an alternative, high-quality setting for outpatient procedures. The Basic Requirements Hea...

  Ambulatory Surgical Centers (ASCs’) are very busy places with a constant influx of patients; hence additional administrative tasks can be time-consuming. With ASCs’, there may be challenging times when deadlines are short and compliance regulations are stringent, so managing billing can be a costly affair in ways more than one. Therefore, outsourcing may seem to be an effective option for Ambulatory Surgical Centers. Outsourcing ASC billing can be beneficial in many ways as listed. Furthermore, there are a lot of aspects that need to be taken care of when billing. Any negligence can cause a loss of revenue. The in–house team may or may not be able to cope with the changing regulations resulting in the submission of incorrect bills. Moreover, the ASC teams’ primary role would be to attend to the patients and the simultaneous billing could seem like an added stress. Industry Snippet The ASC industry is pegged at 28 billion dollars with an annual growth rate of 4%. It is employ...

  Denied ASC claims and moderate repayments jeopardize profits and are a window into the trustworthiness of the procedures and work process of surgery centers. In this blog, we will look at some of the striking reasons for denials in surgery claims and also address and ideally lessen the recurrence of issues brought about by denied claims. Missing Documentation Connected to the Case Payers may require extra documentation, for example, the agent note or embedded receipt, connected to the case, which experts suggest can be a slowing down strategy by the payers to abstain from paying the case. To refrain from accepting persistent solicitations for extra documentation, you can sit down with the payer and lay out which reports are expected to get the case paid. Generally, the payer will ask for medicinal records for one case, and afterward an operation note for another, and afterward something else for another. The Issue with Payer’s Framework for Claims and Payments If your surg...

  With regard to medical coding and billing, analyzing every part of the task is important for ensuring minimal errors. For some bustling Ambulatory surgery centers, overseeing the billing procedures is a consistent battle, and the explanation of which is lost behind incomes. To help ASC manage an efficient charging process, outsourcing the surgical center billing would help a lot in dealing with a patient’s claims, reimbursement, and errorless billing documentation. Keep reading to learn ASC billing and coding. Here are some things that ASC Billing Managers should keep in mind for a smooth Billing Process: 1. Maintain Records of Unbilled Patient Accounts Patient records with balances ought to be checked at all times. Many facilities have a choice to prepare electronic patient statements through a clearinghouse from their practice administration framework, or they can print paper claims right from their office. How regularly this is done depends on the facilities; most facilit...

  ASC billing and coding is one critical undertaking, which if not performed wisely could lead the facility to the threshold of business losses. As Healthcare provider and payer regulations keep altering each year, the billing department of an ASC needs to refurbish their old charging provisions with new ones. But, as all problems today have a solution, so do this, and this is where  Outsourced Medical Billers and Coders  come to the forefront.  Outsourcing ASC Billing provides long-term profitability and the opportunity to grow without disrupting the ongoing RCM cycle of your practice. Choosing the right billing agency to handle your claims while outsourcing company charging prerequisites should not be taken lightly. There’s a significant amount of money and trust involved as you are relying on another person with your revenue cycle, which is the lifeline of your practice. Before selecting the right company, Physicians need to become as informed as pos...

  Compliance guidelines that govern the Ambulatory Surgery Center’s reimbursement are wide-ranging, complex, and ever-changing. Hence, it’s important for ASCs to hire or partner with Ambulatory Surgery Center medical billing and coding management consultants who understand the legal rules placed on ASCs, including specialized coding, accreditation, documentation, and reimbursement care contracts. Here are Prominent Ambulatory Surgery Center Medical Billing Functions are Affecting Your Practice Revenue The Rise in the Number of Accounts Receivable (AR) Days AR basically refers to the average number of days that an ASC takes to collect payments for the services provided. Days in  AR  are one of the main methods that ASCs use to measure their financial performance. The factors impacting the AR days are procedure scheduling, patient pre-registration, insurance verification, patient financial counseling, patient payment plans, and patient collections. An important tip her...

  Medicare covers surgical procedures provided in freestanding or hospital-operated ambulatory surgical services centers (ASCs). In January 2008, Medicare began paying for facility services provided in ASCs— such as nursing, recovery care, anesthetics, drugs, and other supplies—using a new payment system that is primarily linked to the hospital outpatient prospective payment system (OPPS). (Medicare pays for the related physician services—surgery and anesthesia—under the physician fee schedule.) Like the OPPS, the ASC payment system sets payments for procedures using a set of relative weights, a conversion factor (or base payment amount), and adjustments for geographic differences in input prices. Beneficiaries are responsible for paying the Part B deductible and 20 percent of the ASC payment rate Approved Procedures of Ambulatory Surgical Services The unit of payment in the ASC payment system is the individual surgical procedure. Each of the approximately 3,600 procedures appr...

  Ambulatory surgical centers have certainly been a revolution. However, there are some surgical procedures wherein the physicians working at the facility have been subjected to a pay cut or the revenue generated for their procedures has not been fully paid. Well, various reasons hamper the revenue cycle of ASCs, but the most problematic region for the losses is improper medical billing and coding structure. Yes, you heard that right, because this has become a falling trend where the in-house accounting department is finding it difficult to verify and code the perfect procedures while tackling the prerequisite of healthcare providers as well. While procedures like the spine, orthopedic surgery, and ophthalmology are known as top revenue generators, specialties like plastic surgery, oral surgery, and urology regularly face revenue losses. In this Blog, Here we discussed the list of procedures where ASCs are losing money. Here is a List of Procedures Where ASCs are Losing Money: ...

  When performing outpatient procedures, many orthopedic surgeons operate in either ASCs or a hospital-based outpatient department (HOPD). Although some of the workflows and services offered may appear similar between the two, the background operations are substantially different from business and regulatory perspectives. An HOPD is owned by and typically attached to a hospital, whereas an ASC is considered a standalone facility. The goals of this study were to compare the utilization and cost of ASCs vs HOPDs. The difference between an ASC and HOPD specifically refers to the regulations that apply to the center; therefore, a “freestanding” surgery center can still be classified as an HOPD if it is within a 35-mile radius of the hospital and falls under the same financial and administrative contracts. Similarly, a facility can be operated by a hospital and still maintain ASC status if it is an independent entity financially and administratively with its own Medicare agreement. ...

  Modifiers are two-digit symbols added to CPT procedure codes to signify the procedure has been altered in some way. Modifiers are accepted by Medicare and most other payers, however, using modifiers correctly can be confusing, since not all payers want modifiers used the same way. Medicare defines the ASC facility’s Global Period to be 24 hours from the time the first procedure begins – it is NOT 10 or 90 days like the physician’s Global Period might be. However, some payers other than Medicare might consider the Global Period to be 48 – 72 hours for ASC facilities. Some Modifiers are for use by physician practices only, some for use on facility claims only, and some are for use by both provider types. In this Blog, we have discussed the correct use of modifier 50 in  ASC billing . Not using Modifiers according to each payer’s specifications can cause unnecessary denials or cause claims to not pay properly. Certain Modifiers are for use because the patient had to return t...

  ASCs, bring revolution in surgical care who led to the establishment of affordable and safe outpatient surgery. Moreover, The ASC industry is ahead of the curve in identifying avenues for improving the delivery of health care. ASCs are a rare example of a successful transformation in healthcare delivery. Hence stakeholders must understand about ASCs and their benefits and growth factors of ASCs: What is ASC? ASCs are modern healthcare facilities that offer patients the convenience of having surgeries and procedures performed safely outside the hospital setting. The first ASC facility was opened in Phoenix by two physicians in 1970. These physicians saw an opportunity to establish a high-quality, cost-effective alternative to inpatient hospital care for surgical services. Benefits of ASCs Today, physicians are continually providing the impetus which helps in the development of new ASCs. Physicians have realized that they gain increased control over their surgical ...

  With patients having more financial responsibility for their healthcare, outpatient settings like ambulatory surgery centers are becoming more attractive to patients. A research report from Bain & Co. estimates that the number of procedures taking place in outpatient surgery centers will rise from 23 million in 2018 to 27 million in 2021. As per the same report, out of all outpatient surgeries done in the year 2017, half were performed by ASCs. Now as things are settling down after the corona pandemic, these numbers are again looking realistic. Before getting prepared for this growth potential, you have to streamline your current ASC billing process. In this blog, we discussed Ambulatory Surgical Center (ASC) billing challenges and ways to counter them. We are confident that these tips will help in improving your Ambulatory Surgical Center (ASC) collections.  Tips for Improving Ambulatory Surgical Center Collections Process Always Take Prior-Authorization Prior to t...

  Beginning January 1, 2008, the CMS publishes updates to the list of procedures for which an ASC may be paid each year. In addition, CMS publishes quarterly updates to the lists of covered surgical procedures and covered ancillary services to establish payment indicators and payment rates for newly created Level II HCPCS and Category III CPT Codes. Keep reading to learn ASC billing and coding. The complete lists of ASC-covered surgical procedures and ASC-covered ancillary services, the applicable payment indicators, payment rates for each covered surgical procedure and ancillary service before adjustments for regional wage variations, the wage-adjusted payment rates, and wage indices are accessible on the CMS Web site. To be paid under this provision, a facility must be certified as meeting the requirements for an ASC and must enter into a written agreement with CMS. ASCs must accept Medicare’s payment as payment in full for services with respect to those services defined as AS...