Understanding the current trends on ASC Billing Services
The total
healthcare expenditure has seen an exponential increase in recent years. Seeing
this growth, the Centers for Medicare
and Medicaid Services initiated new programs and payment systems that can
help reduce overall costs while enabling physicians and healthcare providers to
offer cost-effective care to their patients.
Over the
years, the healthcare infrastructure has also seen an increase in outpatient
procedures that were conducted in ambulatory surgical centers (ASCs). ASCs
exclusively provide outpatient surgeries which are a same-day or 24hour stay,
typically focusing on a small subcategory of regular procedures and treatments.
This approach allows ASCs to reduce the overall costs of surgery and those
linked with post-operative care while allowing healthcare providers to receive
similar outcomes and ensure quality patient satisfaction.
Since the
Affordable Care Act, reimbursements in ASCs have reduced approximately to
42% as compared to hospitals for the
same procedure. This has reduced the growth and extensive use of ASCs. In spite
of these changes, the ASC sector still witnessed an increase in revenue by $24
billion with an annual growth rate of 5%.
This
welcomed a financial opportunity for many large practices, healthcare
providers, and hospital systems in recent years.
Here are a few trends in ASC Services that you
should know
● Ambulatory
Service Center billing is not actually centered on a specific medical specialty which means
it doesn't involve any specific types of procedures or diagnoses. Therefore,
Ambulatory Surgery Center billing is completely different from any other type
of physician or facility billing. Unlike other medical specialty billing, ASC
billing companies do not require learning highly specialized guidelines or
rules to ensure reimbursement for services.
● For ASC billing services, you will first have
to qualify by adhering to a certain set of requirements and also have a written
agreement with CMS. In order to pay for ASC services, the service must be
stated as medically necessary but the medical procedure doesn't have to be
performed at an ASC as well. This call is completely given to both the provider
and the patient.
● Usually, ASC billing uses similar codes,
regulations, billing systems, and many of the same billing and coding
guidelines used by the medical industry. But what makes it so different is that
its codes are done through a CMS-1500 claim form, not a facility claim form,
unlike hospital
billing that
uses the UB-04 claim form while the practitioners and remaining outpatient
providers use the CMS-1500 form. Think of Ambulatory Service Centers like a
medical specialty combined into one. Outsource ambulatory surgical center
medical billing services to stay updated with the latest regulations.
● With respect to the Total Knee Arthroplasty
which became a part of the Medicare ASC-payable list for 2020, Medicare has
assigned a specific code to it. It is called the "device-intensive
indicator". This will not offer any separate reimbursement for the
implants utilized in the Total Knee Arthroplasty, Medicare will ensure it adds
a portion of the device along with the complex TKA Medicare reimbursement
charges.
● While working with bundled payments for claims
processes, it is recommended to work alongside providers to negotiate the terms
of the contract. This can help receive a confirmation on whether one claim will
include the professional, anesthesia, and surgery free while discussing the
payment distribution as per documentation that is operationally efficient and
comes with lesser billing complexities. It is a complex task since the payers
wish to have all the services within the same claim and handling this might
need some assistance. Hence outsourcing ASC billing services can be a good
option.
● Billing procedures for ambulatory surgical
centers depend on the type of facility chosen and the location of treatment.
Payment for ASC services is based on HMSA's
eligible charge. This eligible charge for a covered service is one
all-inclusive rate based on the highest Outpatient Surgical Procedure-Related
Group category of the procedure code billed.
Why outsource ASC billing?
Outsource
Ambulatory Service Center billing service to 24/7 Medical Billing Services to receive
the most professional and certified team who ensures your billing system is
always following the latest trends of the industry. ASC can be complex and we
at 24/7 Medical Billing Services would like to simplify it for you so that you
can focus on your services while we handle your billing system.
About 24/7
Medical Billing Services:
We are a
medical billing company that offers ‘24/7 Medical Billing Services’ and
support physicians, hospitals, medical institutions and group practices with
our end to end medical billing solutions. We help you earn more revenue with
our quick and affordable services. Our customized Revenue Cycle Management
(RCM) solutions allow physicians to attract additional revenue and reduce
administrative burden or losses.
Contact:
24/7
Medical Billing Services
Tel: +1
888-502-0537
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