5 Common Errors With ASC Billing
In the
last few years, Ambulatory Surgical Centres (ASC) has become one of the
fastest-growing medical services. However, the ASC
billing and coding is different from the physician, surgeon, or hospital
billing. Hence, the billing department of an ASC facility has to be aware of
the various guidelines that Medicare often uses compared to the other payers.
Furthermore, different payers differ regarding the approved procedures, medical
necessity, and other requirements for filling out the forms for reimbursement.
The
lack of awareness of all these and the regular updates published by CMS every
quarter on the lists of surgical procedures covered, the ancillary services
covered for establishing payment indicators, and payment rates can be
challenging for ASC billing. Added to this, the newly created Category III CPT
codes and Level II HCPCS make the billing and coding process difficult,
resulting in some common billing errors.
For any
ASC practice, it is essential to know these five common billing errors to
ensure they do not lose out on revenue. Here is a list of five errors that
mostly happens in ASC billing.
1. Lack of Understanding of the Managed Care Contract
The
biller of your facility must understand in detail and have a copy of all the
managed care contracts. The knowledge of the contract must include:
·
The time you will
get for submitting the claim
·
How long the payer
will take to review the claim and make the payment
·
What is the
methodology of payment?
·
When and why a payer
can reduce the payment and reduce multiple procedures
·
How to appeal the
claim that has been denied or rejected.
The knowledge
of all these and post payments and follow-up can improve your revenue cycle
management. For instance, when you know the managed care contract in detail,
you can avoid taking an implant case that would charge $3,000 when the carrier
won't reimburse the implant more than $2,000.
Understanding
the ins and outs of the contract can help your ASC facility be a more
profitable centre where you are aware of the procedures that can be carried out
with successful reimbursements.
2. Medicare and the SNF Condition
Even
when you have all the proper paperwork, you need to know the Skilled Nursing
Facility (SNF). Medicare
will refuse to reimburse for any ASC services conducted within the SNF. The
patient will not get any reimbursement for treatment in such a case, so be
aware of the SNFs in the area before you take the patient in.
3. Getting Appropriate Authorization & Verification
Before
conducting a procedure, you need to understand the coverage a patient receives
and determine the party's responsibility. Part of it also includes verifying
the edibility of the claim and the address of the claim.
Failure
to get the verification and the appropriate authorization often results in
reimbursement delays. Hence, all the paperwork must be done before undertaking
the correct procedures and ensuring whether costly implants are covered.
In the
case of working with out-of-network carriers, the failure to ask specific
questions, like the reimbursement amount, can result in a loss of profitability
for the case. Also, it is necessary to conduct pre-negotiation coverage with
the carrier for any uncovered procedures and get the commitment in writing. Unless
it is written down, the chances are you won't get paid for it.
4. Non-HIPAA Carriers
Like
any other healthcare service provider, ASC also depends on standardized codes
set by Medicare and CPA to get paid. However, several non-HIPAA carriers will
not pay you when Medicare standardized codes are used. Therefore, you need to
know the codes of these small carriers exempt from HIPAA so your reimbursement
is not rejected.
5. Coding Errors
One of
the top five reasons ASC claims get rejected is wrong coding and the failure to
put the correct codes in order. When you put codes in the bill, always ensure
to place the highest reimbursement code and then gradually lower it. If there
is any cut on the second or following code reimbursement, you would like to get
it for a lower reimbursement amount than the higher one. For instance, if there
are two codes in the bill, one for $1,000 and another for $500, where the
second procedure will get paid half in the list, you would want the cut on $500
instead of $1,000.
The
wrong coding between the surgeon and ASC would result in procedure
discrepancies, leading to claim denial or rejection. Both the ASC billing staff
and the surgeon must be on the same page and have proper knowledge and
education on the current ASC coding.
How to Deal with these Errors?
Undoubtedly,
there are many ASC who have dedicated billing departments and staff. But the
complicated billing procedures with the ever-changing codes and regulations put
a question mark on their revenue. In such a case, the best way to beat these
errors and any pitfalls in ASC billing is by partnering with the experts of
24/7 Medical Billing Services.
This outsourced
Ambulatory Surgical Centres billing company has a specialized and
dedicated ASC billing staff who can help overcome these errors and put the best
revenue management cycle in place for improving the practice's outcome.
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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