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 essential for ASCs to maintain

  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 start f

  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

  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 Ambulatory Surgical Cen

  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 insurance p

  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 Healthcare facilities

  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 employing

  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 surgery

  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 facilities

  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 here would be set

  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 approved

  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 to the OR

  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 the date o

    Basics of ASC Billing An Ambulatory Surgical Center (ASC) is defined by CMS as a facility with the sole purpose of providing outpatient surgical services to patients. ASC is a facility that, very simply, specializes in outpatient procedures. Procedures done at an ASC are more extensive than those done at the typical provider’s office but are not so involved that they require a hospital stay. The basics of ASC billing (Ambulatory Surgery Center) are completely different than any other type of billing. For ASC services to be paid, the service must be determined to be medically necessary. Generally, there are two primary elements in the total cost of performing a surgical procedure: The cost of the  physician’s  professional services for performing the procedure The cost of services furnished by the facility where the procedure is performed (for example, surgical supplies and equipment, and nursing services). In general, the Medicare program pays ASCs 80 percent of the lesser

  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 ASC se

Despite the fact that the basic observation might be that using the services of an Ambulatory Surgical Center (ASC) will spare cash, as contrasted to using the services of hospitals for outpatient surgery. However, this may not generally be the situation. Actually, the outcomes can differ significantly from state to state. A restorative office handles the regulatory errands for a therapeutic practice, clinic, or another medicinal facility including welcoming patients, planning appointments, registration, and enlistment; also collecting cash and various different assignments including medical billing. While the vast majority of alternate undertakings performed by the medicinal office are the same overall healing centers, ambulatory hospital billing services are most certainly not. If you ask most medical billers, they will mention that there are noteworthy contrasts in the handling of medical cases over various claims, specialties, and facility services. There is a flat-out contrast in

The beginning of the   Patient Protection and Affordable Care Act  resulted in millions of Americans becoming insured on plans with out-of-network benefits. Also, this act has narrowed insurance networks which left many providers completely out-of-network. Therefore, the out-of-network strategy for   ASC   is only revenue enhancing strategy for some ASCs. There are some key opportunities available with out-of-network offerings and you will get the details of opportunities in the following briefs: The rise in overall reimbursement The changing and sometimes volatile world of insurance can be stressful for practitioners who desire a more predictable income stream. Fortunately, there are some ways that exist to improve your reimbursements and it starts with developing a good out-of-network strategy combined with the right expertise. You can avail the best pay-off by creating a hybrid strategy that includes an out-of-network and in-network strategy. Moreover, you can enhance revenues by ma

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 Ambulatory Surgical Center to Improve the Patient Collections Process Always Take Prior-Authorization Prior to the

The number of visits to ambulatory practices fell by nearly 60 percent in the early stages of the pandemic which leads to financial pressure on sustainability for practice owners and administrators. Moreover, frantic patients are the main contributor to the sudden rise of daily call volumes as fear of the virus added a new layer of stress and anxiety. In such situations, providers opted for various critical decisions as reduced staff struggled to meet the demands of patients under new safety guidelines. As a result of this turbulent time, many aspects of ambulatory practices have undergone a transformation. Current Trends in Ambulatory Practices: Position Yourself for Success and Sustainability In the current dynamic healthcare environment, the efficiency and effectiveness of both your practice and business processes will drive your success. Today RCM has become more complicated and critical due to changes to payment codes, managing the intricacies of payer billing, and documentation r

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 Ambulatory Surgical Center to Improve the Patient Collections Process Always Take Prior-Authorization Prior to the