Medical Billing Blogs

  Making a choice between in-house and outsourced revenue cycle management (RCM) has been a long topic of discussion. As an Ambulatory Surgery Center leader, you would have probably realized that the billing process is the lifeblood of your center. When it's working properly, everything seems to fall into place. Otherwise, you would have either witnessed or dealt with issues involving partial or non-collected payment, delayed payment, or finding (and retaining) capable local talent. This perplexing question has no one-size-fits-all solution. While both approaches have proven to be successful for many healthcare centers, your decision should be based solely on the age and size of your center, the costs associated with running the practice, volume metrics, and what your center requires. Are you still perplexed? Let's have a look at both the approaches: In-house ASC Medical Billing Pros ●         Flexibility You are in a better position t...

  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 ...

  One of the fastest-growing medical services in the healthcare industry is the Ambulatory Surgical Centres (ASC). However, with the rise in the ASC, there are a few things that the medical billing department needs to know when it comes to ASC medical billing before filing the claims for the services they have rendered. One needs to be aware of Medicare's different guidelines for ASC and the payers. Moreover, the payers have different medical approval procedures and other necessities when filling in the requirements for the operations. As a result, even the experienced ASC billers sometimes find it challenging to keep them updated in managing the claims. That’s why, the providers and the healthcare facilities usually prefers to partner with medical billing companies. As the ASC medical billing and coding are different and a bit more challenging than the typical physician billing claims, there is often room for claim denials and loss of revenue. Hence, it is always worthwhile...

  Medical billing consists of hundreds of pages of updated rules, regulations, and legislation, not to mention thousands of billing codes. And, navigating them is already a challenge for practices. Over the last few years, patients and insurers have continued to pressure the health system and hospitals to move towards ambulatory surgery centre (ASC) billing from hospital outpatient department billing (HOPD). The reason is ASCs billing can be a cost-saving procedure. But to understand how it can be cost-saving, one needs to understand the difference between ASC and HOPD. The Difference between ASC & HOPD The primary difference between ASC and HOPD is based on the regulations that apply to the centres. For instance, a stand-alone surgery centre can still be termed as HOPD when it falls under the same administrative and financial contracts as a hospital that is within a 35-mile radius. On the other hand, a facility can have the ASC status despite being operated by a hospi...

    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 compar...