Outsourcing Billing services for Ambulatory Surgical Center (ASC) simplifies the complexities and challenges involved and results in higher ROI. Offshore Outsourcing can qualify US-based Medical billing companies for greater benefits and profitability. Ambulatory Surgical Center have more specifications and specialty-based nuances in charting out the claim and processing them with the insurance payor; which makes it cumbersome and laborious to be handled In-house. Let us try to understand the complexities involved in billing for ASC to know why Outsourcing has become the latest trend in ASC specifically.
What is Ambulatory Surgical Center?
Ambulatory Surgical Centers are organizations that provide outpatient Surgical Services as a part of a huge medical group, hospitals, or as an independent facility. CMS has mandated only certain surgical procedures can be done within an ASC setup. Such distinctions and specifications from CMS and Medicare protocols make ASC different from other specialties. For this reason, the medical billing process for ASC can be complicated and intricate comparatively.
Challenges in ASC Medical Billing and Coding
Medical Billing and Coding for ASC can be completely different when compared to other medical specialties or the usual physician billing or facility billing as they majorly are a combination of Hospital and Physician Medical Billing claimed on the professional claim form CMS 1500.
- ASC Billing uses Current Procedural Terminology (CPT) and Healthcare Common Procedural Coding System (HCPCS) codes.
- Since ASC’s cover most of the hospital-based services but are billing on the physician billing claim form billing and coding for ASC services can be entirely different and versatile though the same guidelines and protocols are used.
- CMS and Medicare allow only certain surgical procedures can be done in ASC, which makes the billing and reimbursement from Insurance difficult with restrictions on OON coverage.
- It is mandatory that ASC provides services that have been diagnosed by Primary Care Physicians (PCP).
- Frequent release of upgrades in coding guidelines and billing regulations can add up to the complexities involved in billing and coding for ASC furthermore; which necessitates an experienced billing and coding team with knowledge of ASC claims processing
Sourcing and retaining highly experienced ASC billers and coders can be a pain point with the increasing attrition ratio and the staffing issues with the recent pandemic. Inadequate or inexperienced staff can affect the revenue cycle management and monthly collection. Offshore Outsourcing can mean you have an expert team to rely on at times of hardship or uncertainty. Outsourcing ASC billing can be beneficial in many ways as listed below:
- Skillful handling of claims understanding the specialty-based and client-based nuances.
- Insightful approach with the insurance carriers knowing how to deal with claim rejections, denials, and low payments ensuring to close the claim with maximum reimbursement.
- Uninterrupted service coverage unlike in in-house billing when staff absenteeism and attrition can take a toll on your billing process.
- Completely eliminates the overhead cost of hiring, recruiting, training, staffing, infrastructure, upgrading to advanced technological tools, and adapting your team to them.
- Dedicated team and account managers to ensure smooth and stressless functioning of complete Revenue Cycle Management focusing on your bottom line.
Understand Current Trends in Ambulatory Practices
2021 has been a year of turbulence for almost all sectors including the medical industry. Within Healthcare many specialty-based practices and medical groups sustained unexpected falls in patient visits affecting economic conditions. Ambulatory Surgical Centers (ASC) got affected drastically during COVID-19 and the pandemic. However, the current trends show ASCs to be the fast-growing segment in the Medical field. This article aims at understanding the current Trends in Ambulatory Surgical Centers.
Upgraded Technology and Techniques:
The recent rise in new technology for non-invasive surgeries, Advanced operating facility set-ups. Upgrading your ASCs with improved technologies can guarantee targeted financial benefits and business growth.
Telehealth and Virtual Care:
With Advanced technology upgradation practices can now focus on patient care based on patient convenience. Mobile apps and telehealth setups increase patient visits. Providing virtual or remote patient care is a trend that has helped Ambulatory Practice set forth toward significant success.
Prioritize Patient Care:
ASC needs to be fully focused on providing undivided attention to Patient care to ensure quality treatment and patient satisfaction. Unlike in-patient setups or hospital stays, ASCs have patients undergoing surgical procedures within the stipulated time or mostly within 24 hours. During these short hours of service, both the physicians and the patient expect a stress-free atmosphere to ease the procedures. With a team of billing and coding experts to handle the billing functions, ASCs should be able to succeed as the best service provider in their locality.
ASC billing and Coding:
Coding guidelines for ASC are regularly updated, and coders and the billing team involved should be following the CMS guidelines to avoid any miss, leading to denials. With experienced coders and billers assigned to handle ASC billing, any practice should be able to sustain through the pandemic and further.
Outsourcing ASC Billing Service:
With the intricacies and complexities involved in running an ASC practice, it is advisable to have the billing process handled by a Billing Partner with expertise and experience in ASC Medical Billing Service which indirectly guarantees you safe and secure billing with commendable results in cash-flow and patient care.
Offshore Outsourcing:
The benefits of Offshore Outsourcing are undoubtedly greater comparatively. With the time advantage and cost savings, Offshore outsourcing has proved to be the most promising choice for billing partnerships. With the ongoing pandemic, Offshore Outsourcing has seen tremendous growth as many practices and billing companies have adopted this business module to sustain and improvise. Listed below are the benefits of Offshore Outsourcing ASC Billing:
- A well-established Medical Billing Company has hands-on expertise handling multi-specialty billing process
- Experienced and skilled team with regular training on updates and changes
- Coders and billers have experience handling claims for various payers, making it easier to adapt to client-specific or payor-specific billing guidelines
- Increased Quality percentage and denials under control.
- Efficient Accounts Receivable Management and Denial Management
- End to end Revenue Cycle Management
Common Billing Mistakes That Drive Down ASC Revenue Cycle
Let us look in detail at the billing mistakes that drive down ASC Revenue Cycle
Missing on Insurance Eligibility and Benefit Verification
Verifying Insurance Eligibility and Benefits prior to the services coverage is essential to determine the payment responsibilities, and avoid unnecessary confusion and follow-ups post services. This will also help curb significant delays in reimbursement due to insufficient or incorrect claim information.
Failure to obtain Prior Authorization and Referral
Ensuring to receive appropriate Authorization and Referral numbers as and when required as per the policy should be part of the streamlined billing process to enhance the quality billing process
Delayed Claim Submission
The complexities involved in billing for ASC might result in delayed claim submission, however, it is essential to ensure the files are worked on and submitted within the Turnaround Time (TAT). This can be achieved by having a streamlined billing process along with a trained and experienced team assigned to handle ASC claims.
Lack of Streamlined Billing Process
ASC billing can be more challenging and complex than billing for other specialties, however, a streamlined billing approach with appropriate guidelines and process protocol can help avoid billing glitches and ensure smooth and faster billing.
Neglecting Critical Information
Understanding payer contract nuances, coding specific guidelines and abiding by CMS contract rules and regulations will help enhance your bottom line. In addition, ASC billers should also be updated with Managed Care Contracts payment methodology and carry-based policies to ensure your process is intact at every point of the Revenue Cycle Management
Ignoring Medicare payment guidelines for ASC Billing
Medicare has listed some guidelines on payments for ASC billing services according to which ASC services are paid under Medicare part B and requires the claim to be submitted in Claim form CMS 1500 only. There are some commercial payors who also accept ASC claims in CMS 1500 while other insurances also allow the usage of the UB04 claim form. Below listed the Medicare ASC billing and claim submission guidelines.
- ASC must not include separate line items or HCPCS Level II codes as separate bills for procedures, services, drugs, devices, DME, etc.
- ASC will be paid for these but will be included as a package in the allowed payment. For example, the allowance for surgical procedures itself will cover all services, drugs, devices, post-op pain management, and other items.
Outsourcing ASC Medical Billing
With all the above-mentioned complexities involved, Billing and Coding for Ambulatory Surgical Centers (ASC) need a professional and streamlined approach to ensure maximized productivity. Outsourcing ASC Medical Billing to an offshore-based Medical Billing Company with excellent client retention and expertise in handling different specialties can improve your overall financial health.
6 Critical Things to Know Ambulatory Surgery Center Billing & Coding Services
Many Providers and healthcare organizations partner with experienced medical billing companies in the hopes that they would be offered ASC billing services as well. However, most US medical billing companies lack the skill to process ambulatory surgical center billing. ASC medical billing and coding are not like processing normal physician billing claims. It has so many differences and is quite complicated in terms of billing and coding. As there is room for huge claim denials, the in-house medical billing team cannot tackle both normal and ASC billing independently. Therefore, partnering with an offshore vendor that is skilled in Ambulatory surgical center billing would be the best solution. In this article, let’s learn about the 6 critical things about ASC billing and coding services and how offshore vendors help in tacking them:
Facts about ASC Billing: In what way ASC medical billing and coding is different from normal physician billing? To know the answer, first, we have to understand how ambulatory surgical centers work.
- According to Medicare, ASC is an independent organization that provides outpatient surgical services exclusively to its clients
- Sometimes, it can be run as a part of a huge healthcare facility and called a ‘provider-based department of the hospital
- ASC do not provide office visits, laboratory services or run diagnostic tests
New Trends:
- To be eligible for reimbursements, Medicare expects ASCs to sign up a participating-provider agreement with CMS
- To reduce huge patient bills, CMS is planning to make ASCs into ‘bed-less hospitals.’ This way, patients can get their surgeries done and be discharged on the same day. They can recuperate in the comfort of their own homes by getting in touch with their Providers via phone
How is Ambulatory Surgical Center Billing Done?
- Unlike normal physician billing, ambulatory surgical centers use a combination of both hospital and physician billing
- Most of the ASC billing services are billed using CPT and HCPCS Level II codes. However, some insurance companies allow ASC services to be billed using ICD-9-CM codes
- ASC claims should be filed using the CMS 1500 form as per Medicare guidelines
- Medicare also requires the usage of CG modifier to distinguish between ASC bill and physician bill
Approved Surgical Procedures: According to CMS, only certain approved procedures can be done under an ASC setting. The list includes,
- Non-emergency and life-threatening procedures
- Procedures that cannot be done in a physician’s office safely
- Elective procedures
- Urgent procedures
Best Practices to Avoid Critical Errors: Some of the best practices to avoid critical errors in ambulatory surgical center billing are as follows,
- It is always advisable to read the complete surgical report instead of just considering the procedure heading while coding
- Sometimes, a procedure started arthroscopically might have been changed to an open procedure due to complications. It should be considered an open procedure only during billing. Many coders mistakenly bill for both procedures, which is wrong
About e-care India:
For those companies who are on the lookout for an experienced ASC billing vendor, e-care India will be the prudent choice for medical billing services. It has expertise in working for over 25 medical specialties and with more than 30 billing software, which most billing companies in other nations lack. It has all the necessary security certifications including the SSAE 18, which is an added advantage. To know more about e-care and its services, log on to www.ecareindia.com.