Ambulatory Surgical Center Billing: Current Trends, Common Billing Errors, and Six Important Things to Know

Ambulatory Surgical Center Billing: Current Trends
  • Avatar photo Victor Bala
  • Jul 9 2024
  • Reading Time: 13 minutes.

Ambulatory Surgical Center (ASC) billing outsourcing services simplify and streamline the process, leading to a greater return on investment (ROI). Offshore Outsourcing can help US-based Medical Billing Companies gain better benefits and profitability. Ambulatory Surgical Centers have more criteria and specialty-based subtleties when it comes to charting out claims and processing them with insurance payors, making it difficult and time-consuming to manage in-house. To understand why outsourcing has become the latest trend in ASC, let us try to comprehend the intricacies involved in billing for ASC.

What is an Ambulatory Surgical Center?

Ambulatory Surgical Centers are organizations that offer outpatient surgical services as part of a large medical group, a hospital, or as a standalone facility. CMS has stipulated that only specific surgical procedures can be performed in an ASC setting. These characteristics and standards from CMS and Medicare protocols distinguish ASC from other specialties. As a result, the medical billing process for ASC can be relatively complex and intricate.

ASC Medical Billing and Coding Challenges

As they are mostly a combination of hospital and physician medical billing claimed on the professional claim form CMS 1500, medical billing and coding for ASC can be very different from other medical specialties or the typical physician billing or facility billing.

  • ASC billing utilizes Current Procedural Terminology (CPT) and Healthcare Common Procedural Coding System (HCPCS) codes.
  • Because ASCs cover the majority of hospital-based treatments but are billed on the physician billing claim form, billing and coding for ASC services can be very varied and variable, even if the same principles and protocols are followed.
  • CMS and Medicare only allow certain surgical procedures to be performed in ASCs, making insurance billing and reimbursement difficult due to OON coverage restrictions.
  • It is required for ASC to deliver services that have been diagnosed by primary care physicians.
  • Frequent updates to coding guidelines and billing requirements can further complicate billing and coding for ASC, necessitating an experienced billing and coding team with an understanding of ASC claims processing.

With the rising attrition rate and staffing challenges caused by the current pandemic, it can be difficult to find and keep highly skilled ASC billers and coders. Inadequate or inexperienced workers might have an impact on revenue cycle management and monthly collections. Offshore outsourcing can provide you with a professional staff to rely on during times of hardship or uncertainty. Outsourcing ASC billing can be useful in several ways, as outlined below:

  • Skilled claim management, with an awareness of the subtleties of specialization and customer.
  • Insightful approach with insurance carriers, understanding how to deal with claim rejections, denials, and low payments, ensuring that the claim is closed with the maximum compensation.
  • Unlike in-house billing, which can be hampered by employee absenteeism and attrition, we provide continuous service coverage.
  • It eliminates the overhead costs associated with hiring, recruitment, training, staffing, infrastructure, upgrading to advanced technological tools, and adjusting your workforce to them.
  • Dedicated team and account managers to guarantee that the entire revenue cycle management process runs smoothly and stress-free, with a focus on your bottom line.

Current Trends in Ambulatory Practices

ASC hospital and ambulatory surgery center billings have been turbulent for almost all industries in 2021, including the medical field. Across healthcare, many specialty-based practices and medical groups saw drastic declines in patient volumes they never anticipated or could afford.

Ambulatory Surgical Centers (ASC) suffered significantly during COVID-19 and the pandemic. However, recent trends show that ASCs are the fastest-expanding section in the medical field. Ambulatory surgical center trends are discussed in this article.

Upgraded Technology and Techniques:

New technology for non-invasive procedures has recently emerged, as have advanced operating room configurations. What is clear, though, is that you want to keep your ASCs at the top of their games by updating them with newer technologies to maximize financial benefit and achieve continuous business success.

Telehealth & Virtual Care:

Thanks to state-of-the-art technology updates, professionals can now pay attention to how they want to provide patient care. Mobile Apps, Telehealth Settings Drive Boost in Patient Visits Ambulatory Practice: Virtual or remote patient care has been a boon for the practice to be successful.

Prioritize patient care:

For that matter, ASC has to eliminate all distractions to deliver only shared attention, resulting in quality treatment and patient delight. As opposed to being an in-patient or hospital stay, at ASCs, patients have their surgical procedures within the specified time frame, which is typically 24 hours. During these brief hours of service, both physicians and patients anticipate a stress-free environment to facilitate treatments. With a team of billing and coding experts handling the billing functions, ASCs should be able to establish themselves as the top service provider in their area.

ASC Billing and Coding:

Coding criteria for ASC are continuously revised, and coders and billing teams should adhere to the CMS guidelines to avoid errors that lead to denials. With skilled coders and billers assigned to manage ASC billing, any practice should be able to withstand the pandemic and beyond.

Running an ASC practice is no simple task, and when it comes to billing, it is better left in the hands of a billing partner who specializes in providing medical billing services exclusively for an ASC. Thus, this indirectly ensures your safe and secure billing, which leads to commendable cash flow and affects patient care.

Offshore Outsourcing

The benefits of offshore outsourcing revenue cycle management are certainly greater.

Time and cost savings:

For billing partnerships, offshore outsourcing has been turning out to be the most suitable option for everyone because it saves time and costs too. As we see, amidst a global pandemic, offshore has grown to an even larger scale of outsourcing than what most practices and billing companies have currently been using in their business models.

Ambulatory surgical center billing services has the following advantages:

  • A well-established medical billing company has hands-on experience handling the multi-specialty billing procedure.
  • Experienced and skilled crew with frequent training for upgrades and modifications.
  • Coders and billers have experience managing claims for multiple payers, making it easier to adjust to billing requirements that are specific to the client or payor.
  • Increased quality and denials are under control.
  • Efficient accounts Receivables and Denial Management.
  • End-to-end Revenue Cycle Management.

Common Billing Mistakes That Drive Down the ASC Revenue Cycle

Let us examine in depth the billing errors that push down the ASC Revenue Cycle.

Insurance eligibility and benefit verification are missing from ASC billing

Verifying insurance eligibility and benefits before service coverage is critical for determining payment responsibilities and avoiding unneeded confusion and follow-ups after services. This will also help to reduce major reimbursement delays caused by incomplete or incorrect claim information.

Failure to get prior authorization and a referral:

To improve the quality of the billing process, the streamlined process should include ensuring that proper authorization and referral numbers are received as needed by the policy.

Delayed Claim Submission:

The difficulties associated with billing for ASC may result in delayed claim submission; yet, it is critical to ensure that the files are completed and sent within the Turnaround Time (TAT). This can be accomplished by implementing a streamlined billing procedure and assigning a skilled and experienced team to manage ASC claims.

The Billing Process Is Not Streamlined:

Ambulatory surgical center billing services can be more difficult and complex than billing for other specialties; nevertheless, a streamlined billing approach with suitable rules and process protocols can help avoid billing errors and ensure smoother and faster invoicing.

Neglecting Critical Information:

Understanding payer contract subtleties, coding specific criteria, and adhering to CMS contract laws and regulations will all benefit your bottom line. Furthermore, ASC billers should be updated with managed care contract payment techniques and carrier-based policies to ensure your process is intact at every phase of revenue cycle management.

Medicare Payment Guidelines for ASC Billing Ignorance:

Medicare has established payment standards for ASC billing services, which state that ASC services are covered by Medicare Part B and that claims must be submitted solely in Claim Form CMS 1500. Some commercial payors accept ASC claims in CMS 1500, and other insurance companies accept the UB04 claim form. Here are the Medicare ASC billing and claim filing guidelines:

  • ASC cannot include different line items or HCPCS Level II codes on separate bills for procedures, services, medications, equipment, DME, and so on.
  • ASC will be compensated for these, but they will be included as a package in the authorized payment. For example, the budget for surgical treatments will include all services, medications, gadgets, post-operative pain management, and other expenses.

Outsourcing ASC Medical Billing

With all of the complications outlined above, Ambulatory Surgical Center (ASC) billing and coding require a competent and streamlined strategy to ensure maximum efficiency. Outsourcing ASC medical billing to an offshore medical billing company with high customer retention and experience managing various specialties might benefit your entire financial health.

6 Important Things to Know About Ambulatory Surgery Centers Billing and Coding Services

Many providers and healthcare organizations work with professional medical billing companies in the hopes of receiving ASC billing services as well. However, most US medical billing organizations lack the expertise to handle ambulatory surgery center billing. ASC medical billing and coding differ from processing traditional physician billing claims. It has numerous variations and is highly sophisticated in terms of billing and coding. Because there is potential for significant claim denials, the in-house medical billing team cannot handle both conventional and ASC billing independently. As a result, engaging with an offshore vendor who is proficient in ambulatory surgery center billing would be the best option. In this post, we’ll look at the six most important aspects of ASC billing and coding services, as well as how offshore suppliers can help with them.

Facts About ASC Billing: In what ways do ASC medical billing and coding differ from traditional physician billing?

To know the solution, we must first understand how ambulatory surgery facilities operate.

According to Medicare, ASC is an independent company that offers outpatient ambulatory surgical services exclusively to its consumers.

  • Sometimes, it might be managed as a part of a large healthcare facility and labeled a “provider-based department of the hospital.”
  • ASC does not offer office visits, laboratory services, or diagnostic tests.

New trends:

  • To be eligible for compensation, Medicare expects ambulatory surgical center billing guidelines to sign up for a participating provider agreement with CMS.
  • CMS intends to convert ASCs into “bed-less hospitals” to lower patient bills. This allows patients to have their operations and be discharged on the same day. They can heal from the comfort of their own homes by contacting their providers via phone.

Ambulatory Surgical Center Billing Services: How Does It Work?

  • Unlike traditional physician billing, ambulatory surgery facilities use a blend of hospital and physician billing.
  • Most ASC billing systems utilize CPT and HCPCS Level II codes. Some insurance companies allow ASC services to be billed using ICD-9-CM numbers.
  • ASC claims should be filed using the CMS 1500 form according to Medicare requirements.
  • Medicare also requires CG modifiers to distinguish between ASC and physician bills.

Approved Surgical Procedures:

According to CMS, only certain approved treatments can be performed in an ambulatory surgical center billing guidelines setting. This list includes:

  • Non-emergency, life-threatening operations
  • Procedures that cannot be performed safely in a physician’s office
  • Elective procedures
  • Urgent procedures

Best practices for avoiding critical errors:

Here are some of the best strategies for avoiding serious errors in ambulatory surgical center billing

  • It is often recommended to study the entire surgical report instead of just considering the procedure heading while coding.
  • Complications may cause an arthroscopic surgery to be converted to an open procedure. It should only be considered an open procedure for billing. Many coders accidentally bill for both operations, which is incorrect.
Avatar photo

Victor Bala

Medical & coding

About the Author:

Victor has over a decade of experience in delivering revenue cycle management services to the US healthcare providers. He has a proven track record of accelerating revenue collection by streamlining the billing, coding and AR processes. His team at Velan has been delivering revenue cycle management cycle, appointment scheduling, pre-authorization and credentialing services to physicians, group practices, and hospitals.

He can be reached at [email protected]

Considering the complexities of healthcare billing in the USA, why choose Velan HCS for your billing services?