Medical Billers and Coders

  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

  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

    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