Overview

Ambulatory Surgery Centers (ASCs) often face unique challenges with their billing and coding processes, which is why this topic comes up frequently in ambulatory surgery center FAQs. While ASCs have made significant improvements by adopting advanced billing software and better EMR/EHR systems, there’s still a clear difference between how ASC billing works compared to hospitals or physician offices.

ASC billing focuses specifically on outpatient procedures performed by physicians, suppliers, and other non-institutional providers, whereas physician billing typically relates to services delivered in clinics, nursing facilities, or inpatient hospital settings. Despite these distinctions, ASCs offer several advantages, including lower costs, improved patient safety, quicker recovery, and less discomfort, making it essential to understand how their billing systems function—especially for those navigating the complex world of outpatient care.

Here are the Top 6 ambulatory surgery center FAQs Explained

1. Which procedures are considered covered by CMS?

Centers need to be aware that not all hospital operations are acceptable in an ASC. To secure Medicare approval, the Centers for Medicare & Medicaid Services (CMS) must ensure that there is no substantial danger to patients or that an overnight stay is not required after the treatment. If you have any hesitations, contact Medicare immediately.

Criteria for approving procedures include the following:

• Not a life-threatening risk
• It’s an elective procedure.
• It’s not safe to perform in a physician’s office.
• Urgent

2. What are the most common billing mistakes in ASCs?

• A lack of clarity in coding: After the surgery, you must specifically describe all the procedures and elements performed. If not, then your coding staff might miss recording some of them. It is crucial since this will determine the billing. When you finish your documentation, check the details to confirm accurate coding.

• Shortage of staff: Take advantage of reputable billing agencies that can handle your billing and coding processes. If you’re short on staff, there’s bound to be recurring mistakes. Get the support you need to help eradicate errors and improve your cash flow.

• Denial tracking is non-existent: There could still be problems with income if you’re not tracking denial patterns. Your staff must track all claim denials, including the insurance that initially refused the claim, their reasoning, and the outcome. Next, you’ll examine the combination data to see if there are any patterns. If you experience denials because of coding errors by one or several payors, you’ll identify the matter and fix it.

3. What are the most common coding errors for ambulatory surgery?

• ASC charges don’t correspond to the procedure performed.
• Waiting for the surgical report to be completed before billing immediately.
• A coding error involves coding based on the procedure headings instead of the particular surgical report.
• Some procedures are billed the same, even if they are different.
• Open and arthroscopic techniques are reported as one procedure.

4. What are the essential coding and billing for ASC charges?

Here are a few coding and billing basics for ASCs:

• Anesthesia services by the operating surgeon are examples of packaged services that are not “pass-through” supplies. Examples of “packaged” services include surgical cloths, splints, casts, associated materials, and anesthesiologist supervision.
• ASCs use a combination of physician and hospital billing, employing CPT and HCPCS codes.
• Pacemaker insertion is covered as part of the ASC but not separately. In the procedure code, the cost will be included as one line item. According to the Medicare Physician Fee Schedule, most ASCs are not allowed to charge their services based on their allowable code.
• Only a few insurance companies permit ambulatory surgical billing to use ICD-10 procedure codes, just as hospitals do.
• Medicare wants to have ambulatory surgical billing done electronically using the CMS-1500 form, while most other insurance companies use the UB92 form.

5. How does the CMS define an ambulatory surgical center?

• The CMS guidelines describe ASCs as a distinct organization that offers surgical services exclusively to
• Medicare-certified hospitals can operate provider-based departments within hospitals or ASCs.
• ASCs must sign a participating provider agreement with the Centers for Medicare & Medicaid Services (CMS) to receive Medicare payments.
• CMS wants to introduce a “bed-less hospital” with the most outpatient services in order to cut costs.
• In addition, patients will recover at home while still communicating with providers via digital means after same-day surgery.

6. What are some modifiers utilized in ASC billing?

• Modifier 74 – an indication that anesthesia was terminated after it was induced.
• This Modifier 76 is an indication that a physician repeated a procedure after the initial one was completed.
• To decide on Surgery- Modifier 57
• Modifier 59 – identified procedures or services, aside from E/M services CPT Modifier 77 – a report on repeated procedures by another physician.

Providing you with the Best

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