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25 New Procedures Approved for ASCs in 2013

  12/28/2012 – The 2013 HOPPS and ASC System Medicare Payment Final Rule approved 16 procedures that HHS (Dept. of Health & Human Services) proposed for the list of ASC covered surgical procedures for CY 2013. In addition, 9 of the procedures requested by the commenters to add to the list were also approved for ASCs [...]

Tags: 2013 CPT Codes, 2013 Medicare Physician Fee Schedule, ASC Billing, ASC Coding, Medical Billing

7 Tips for Building Great Commercial Payor Relationships

  AASC: Written by Heather Linder | September 21, 2012 As published in Becker’s’ ASC Review Note: Jeanne Gilreath and Brice Voithofer from AHS were interviewed recently for this article by Becker’s ASC  Review. Because ASC personnel work with commercial payors regularly, and rely on reimbursements for revenue, fostering a positive relationship with these payors is highly beneficial. [...]

Tags: ASC Billing, ASC Contracts, Medical Billing

EHR Stage 2 “Scope of Practice� Hardship Rule May Help ASCs

  Fall 2012 – Although Ambulatory Surgical Centers (ASCs) are not eligible to participate in the EHR Medicare & Medicaid Incentive Program, the providers who perform services at ASCs are eligible. Eligible professionals (EPs) who practice at ASCs must count those patient encounters as part of the 50% of their patient encounters that must occur [...]

Tags: ASC Billing, EHR, EHR Incentive Program, Meaningful Use

CRNAs and Chronic Pain Management Services

  Fall 2012 – In the proposed 2013 Medicare Physician Fee Schedule,CMShas added language to allow certified Registered Nurse Anesthetists (CRNAs) to perform and bill separately for chronic pain management services. CRNAs have been permitted to bill Medicare directly for certain services since 1989. In some states, CRNAs provide chronic pain management services that are [...]

Tags: ASC Billing, Medical Billing

Arrangements Between Anesthesiologists and Physician-Owned ASCs Require Careful Review

  Fall 2012 - Any physician-owned ASC that is considering a separate entity (ies) to contract with and directly pay for anesthesia services must carefully review any arrangement to ensure compliance with safe harbor and the anti-kickback statute. Recent OIG rulings have highlighted several arrangements that are not permitted or that run substantial legal risk. Two [...]

Tags: ASC Billing, ASC Contracts, Medical Billing

7 Reasons for Claims Denials in Surgery Centers and How to Fix the Problem

Rachael Fields of Becker’s ASC Review recently interviewed Bill Gilbert, Vice President Marketing and Brice Voithofer, Vice President Anesthesia and ASC Services.  This interview was originally published on May 2, 2012, on the Becker’s ASC Review website. Denied claims slow reimbursements, endanger profitability and are a window into the integrity of the processes and workflow of [...]

Tags: ASC Billing, ASC Coding, Medical Billing

NY – EMPIRE BCBS: New Anesthesia Billing Requirements for 2013

10/24/2012 – In early 2013 Empire BCBS will modify anesthesia processing to be more consistent with CMS.  The following was published by Empire BCBS and will become effective for all claims processed on and after February 1, 2013, regardless of the date of service. Time units will be calculated by dividing the total minutes of time by [...]

Tags: Anesthesia Billing, Anesthesia Coding, Coding, Medical Billing

United Healthcare – Patients May Access & Share Personal Health Records

September 24, 2012 – UnitedHealthcare has made it possible for patients to view, print, and save their UnitedHealthcare Personal Health Record (PHR) by clicking on the Blue Button Download My Data® located on their consumer portal called myuhc.com.  Members will now be able to share their PHR with their physicians, giving a more comprehensive picture [...]

Tags: billing, Compliance, EHR, Healthcare Reform, Medical Billing

ICD-10 Final Rule Issued

September 5, 2012 – On August 24, 2012, HHS issued the final rule concerning the transition from ICD-9-CM  to ICD-10-CM diagnosis coding.  As suggested in the proposed ruling in April 2012, HHS has finalized the year delay for the transition to ICD-10 coding from October 1, 2013 to October 1, 2014. Other options suggested by [...]

Tags: Anesthesia Billing, ASC Billing, CMS Updates, Healthcare Reform, ICD-10, Medical Billing, Radiology Billing, Surgery Billing

EHR Stage 2 Final Rule Released

September 5, 2012 – On August 23, 2012, CMS announced the final rule for Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.  The rule specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to successfully participate in the EHR [...]

Tags: Anesthesia Billing, ASC Billing, CMS Updates, EHR, Healthcare Reform, Meaningful Use, Medical Billing, Pathology Billing, Radiology Billing, Surgery Billing

EHR Stage 2 Ruling – Possible Exemptions for Anesthesiologists, Pathologists and Radiologists

September 5, 2012 – CMS has designated the specialties of anesthesiology, radiology and pathology as qualifiers for a new Scope of Practice exemption granted in the EHR Stage 2 ruling announced on August 23, 2012.   This exemption is aimed at eligible professionals (EPs) who: lack both face-to-face interactions with patients, and lack the need [...]

Tags: Anesthesia Billing, ASC Billing, CMS Updates, EHR, Healthcare Reform, Meaningful Use, Medical Billing, Pathology Billing, Radiology Billing

ASCs to Begin Quality Reporting on Oct. 1

September 5, 2012 – Medicare participating ambulatory surgical centers (ASCs), certified as of January 1, 2012, must begin reporting five quality measures on claims with dates of service between Oct. 1 and Dec. 31, 2012 to be eligible for full Medicare payment in 2014.    ASCs that fail to successfully report quality codes on at [...]

Tags: ASC Billing, ASC Coding, CMS Updates, Healthcare Reform, PQRS Incentive Program

CT BCBS (Anthem) – Multiple Surgery Updates

Anthem BCBS has recently updated their claim editing rules, ClaimsXten to Version 4.4. Multiple Surgery – professional   Effective Date:  July 1, 2012   28826 – Arthroscopy – decompression of subacromial space with partial acromioplasty, with coracoacromial Multiple surgical reimbursement rules will not loner be applied to add-on code 28826. Multiple Surgery Reimbursement  Effective Date:  [...]

Tags: ASC Billing, Coding, Medical Billing, Surgery Billing

Aetna Updates

Arthroscopy – New Coding Policy Effective Date:   9/1/2012 29862 – Arthroscopy, hip, surgical; with removal of loose body or foreign body Modifier 59 will no longer override codes 29862 and 29863 when billed with 29914 – Arthroscopy with femoroplasty 29915 – Arthroscopy with acetabuloplasty 29916 – Arthroscopy with labral repair Scheduling Assistant Surgeons Aetna wants [...]

Tags: ASC Billing, Coding, Medical Billing, Surgery Billing

AMERIHEALTH (NJ) – ASC Fee Schedule Changes

June 20, 2012 – AmeriHealth(NJ) will add the following codes to their ASC Surgery Fee Schedule, effective on service date July 1, 2012. 0184T – Excision of rectal tumor, transanal endoscopic microsurgical approach C9288 – Injection, centruroides, 1 vial C9289 – Injection, asparaginase erwinia chrysanthemi, 1,000 international units C9290 – Injection, bupivacaine liposome, 1 mg [...]

Tags: ASC Billing, ASC Coding, Coding, Medical Billing

UNITED HEALTHCARE – Update to Facility Outpatient Grouper Mapping

 June 20, 2012 – Each year, UnitedHealthcare reviews the Outpatient Procedure Grouper (OPG) mapping used in reimbursing outpatient procedures in hospitals and ambulatory surgery centers contracted under this methodology. Included in the 2012 mapping are nine Current Procedural Terminology (CPT®) or Healthcare Common Procedure Coding System (HCPCS) codes that the Centers for Medicare & Medicaid [...]

Tags: ASC Billing, ASC Coding, billing, Coding, Medical B, Medical Billing

Medicare – New Codes added to ASC fee schedule

June 20, 2012 -  Effective  7/1/2012, five new codes will be added to the ASC fee schedule under CMS. 0302T – Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; complete system (This code replaces C9732) 0303T – ; electrode [...]

Tags: ASC Billing, ASC Coding, Coding, Medical Billing

Highmark BCBS (PA) – New Codes Available for Quality Blue

May 17, 2012 -  Effective April 1, 2012, Highmark made available the following codes available for reporting pay-for-performance measures to the Quality Blue program  CODE DESCRIPTION G8907 Patient documented not to have experienced any of the following events: a burn prior to discharge, a fall within the facility, wrong site/side/patient/procedure/implant event, a hospital transfer or hospital admission upon discharge [...]

Tags: Healthcare Reform

CMS Releases More Information on ASCs Quality Reporting Program

May 1, 2012 – CMS has recently released proposed guidelines for Medicare’s new ASC quality reporting program.  The Ambulatory Surgery Center Association (ASCA) has released a summary of these guidelines, which are presented below and can be found on their website, along with more specific guidelines on what ASCs must do to participate in this program.  [...]

Tags: CMS Updates, Medical Billing, PQRS Incentive Program

CMS Clarifies Patients Rights on Day of Surgery

Notice sent by the ASCA  – April 2, 2012 The Centers for Medicare & Medicaid Services (CMS) has issued a letter to its state survey agency directors clarifying that, as long as the information is provided before surgery begins, ASCs can provide notification of patients’ rights, physician financial interests and the ASC’s advance directive policies [...]

ASCA Meets with CMS Over Fee Schedule

March 15, 2012 – During the first week of March, representatives from the Ambulatory Surgery Center Association (ASCA) met with CMS staff responsible for the payment policies in ASCs.  Also attending were representatives form the American Urology Association and the American Association of Orthopedic Surgeons.  As per a statement issued by the ASCA in their [...]

PA – Highmark BCBS – ASC Fee Schedule

March 15, 2012 – Effective Date: April 1, 2012, Highmark BCBS will update their fee schedule for ambulatory surgical centers.  This does not affect facilities that are reimbursed according to Highmark’sAPC-based reimbursement methodology. Usually, Highmark updates their fee schedule on July 1 but has made a business decision to move the annual fee-schedule update to April [...]

NJ – Horizon BCBS of New Jersey – Assistants at Surgery

March 15, 2012 – Horizon BCBS requires that an assistant surgeon (AS) participating in surgical services rendered to a Horizon BCBS member participates in the appropriate Horizon BCBSNJ network according to that member’s benefits. Providers planning to use a nonparticipating assistant surgeon must advise the member of the nonparticipating status of the AS, the out-of-network [...]

RHODE ISLAND MEDICAID – Billing Multiple Surgeries

January 23, 2012 – In 2012, RI Medicaid will pay up to three surgical procedures for the same date of service.  RI Medicaid recommends billing modifier -51 for all three procedure codes and to always bill the modifier in the first position to ensure you receive proper reimbursement for all surgical procedures.   The following [...]

CT – Anthem BCBS Surgery Updates

December 30, 2011  Global Surgery Policy  The global surgery policy was recently updated to clarify that the global surgical package includes the history and physical for pre-operative clearance, unless there is a high risk c0-morbidity which requires surgical clearance from other than the treating physician.  The global surgical package also includes post-operative pain management. Assistant [...]

United Healthcare – Assistant Surgeon Policy

November 17, 2011 – Effective the first quarter of 2012, following CMS’ and AMA’s requirements, the Assistant Surgery Reimbursement Policy will deny assistant at surgery eligible services reported without modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) when reported by Nurse Practitioners and Physician Assistants who, because of [...]

CMS Will Pay for Three Drugs/Biologics in October 2011

October 21, 2011 – Effective October 1, 2011, CMS will pay for the following three additional drugs/biologics when they are administered in conjunction with a surgery performed at an ASC.     CODE Description ASC Rate C1830 Power bone marrow bx needle Contractor Priced C1840 Telescopicintraocular lens Contractor Priced C9286 Injection, belatacept $3.91

CMS Proposes Quality Reporting Program for ASCs

October 21, 2011 – On July 1, 2011, CMS proposed to begin implementing a quality reporting program for ASCs that could lead to a pay-for-performance program for outpatient freestanding surgical facilities.   This program was introduced in the proposed rule that would update the Outpatient Prospective Payment System (OPPS) and payment system for 2012.   Over [...]

CMS Reduces Regulatory Burdens for ASCs

October 21, 2011 – On October 18, 2011, CMS passed a Proposed and Final Rule for ASCs. Proposed Rule Ambulatory Surgical Centers (ASCs) will find two changes:   The elimination of outmoded infection control instructions Elimination of the specific list of emergency equipment ASCs must have on hand and allowing facilities, in conjunction with medical staff and [...]

UNITEDHEALTHCARE – Place of Service and Professional/Technical Component Policy

September 21, 2011 – Effective in the fourth quarter of 2011, following CMS’ guidelines, UnitedHealthcare will begin to recognize an Ambulatory Surgical Center (ASC) as a facility POS (Place of Service) when reported on the CMS 1500 claim form.  POS 24 is a freestanding facility, other than a physician’s office, where surgical and diagnostic services [...]

PA – AmeriHealth – ASC Surgery Fee Schedule Updates

July 20, 2011 – AmeriHealth  made updates to their ASC Surgery fee schedule that became effective on service date of  July 1, 2011.  Codes were added and deleted to follow changes made byCMS to its fee schedule.  You should have received a copy of the updated fee schedule at the beginning of June which would [...]

UNITED HEALTHCARE (UHC) – Surgical Treatment of Obstructive Sleep Apnea

July 20, 2011 – Effective July 1, 2011, UHC  revised coverage rationale: Added language to indicate multilevel procedures Added obstructive sleep apnea severity criteria Revised list of unproven surgical procedures Added medical necessity review criteria for uvulopalatopharyngoplasty, maxillomandibular osteotomy and advancement, and mandibular osteotomy Updated applicableCPTcodes; removed 41130 Updated list of applicable HCPCS codes; removed [...]

PA – HIGHMARK BCBS – Surgical Codes Added to Prior Authorization List

July 20, 2011 - Effective Oct. 3, 2011, Highmark will add 15 codes to its list of outpatient procedures/services requiring authorization.  The following are surgical codes that will require prior authorization: 29914 – Arthroscopy, hip, surgical; with femoroplasty (i.e., treatment of cam lesion) 29915 – Arthroscopy, hip, surgical; with acetabuloplasty (i.e., treatment of pincer lesion) 29916 [...]

TUFTS HEALTH PLAN – Prior Authorization for Total Joint Replacement Ankle

July 20, 2011 – For service dates of July 1, 2011 and after the following ankle joint replacement codes will need prior authorization: 27700 – Arthroplasty, ankle 27702 – Arthroplasty, ankle, with implant (total ankle) 27703 – Arthroplasty, ankle, revision total ankle 27704 – Removal of ankle implant

AmeriHealth – X-Rays Associated with Fractures in the Office setting

AmeriHealth requires all their HMO members and most POS members who use their referred benefits to obtain outpatient diagnostic radiology services at their primary care physician’s capitated radiology site.   However, in some acute circumstances, medically necessary X-rays associated with a fracture may be performed in a specialist’s office.  Hand surgeons, orthopedic surgeons, podiatrists, and [...]

MA – BMC HealthNet Plan – Deletion of Consultation Codes

July 20, 2011 – Effective service date of August 1, 2011, BMC HealthNet will no longer reimburse for consultation codes (99241-99245 and 99251-99255).  These codes will be replaced with:  99201-99215 – office/outpatient visit codes, 99221-99223 – initial hospital visits, and 99304-99306 – Nursing facility care.

National ASC Open House Day – August 11, 2011

June 16, 2011 – On Thursday, August 11, 2011, ASCs across the country will invite those who live and work in their communities to tour their facilities and engage in activities.  For almost a decade, ASCs have used this event to promote health awareness and educate members of their communities about what ASCs are and [...]

New ASC Bill is Introduced in the US House

June 16, 2011 – On June 3, 2011, several USrepresentatives, both Republicans and Democrats, introduced the Ambulatory Surgical Center Quality and Access Act of 2011 (H.R. 2108), aimed at preserving patient access to ambulatory surgical centers. The bill requests policies that would establish Medicare reimbursement for ASCs while encouraging additional cost savings to Medicare.  The [...]

MEDICARE – Same Day Surgery Restrictions

May 19, 2011 – As posted in the ASCA’s Government Affairs Update, Volume I, Issue 9, on April 28, 2011, members of the ASCA’s advocacy team met with officials at the Centers for Medicare and Medicaid Services (CMS) in April to discuss their ongoing concern over restrictions on ASC’s performing surgery on the same day [...]

MA – Neighborhood Health Plan – Spinal Surgery Policy Changes

May 19, 2011 – As part of their efforts to improve services and control their medical costs, NHP has chosen Focus Health to provide NHP with consultative reviews of prior authorization requests for spinal surgery.   Focus Health is a medical management services organization specializing in the evaluation of pain management services, including spinal surgery, [...]

ASCA – New proposed legislation

April 20, 2011 – The Ambulatory Surgery Center Association (ASCA) reports in their ASCA Government Affairs Update  (Volume I, Issue 5 on March 31, 2011) that some of their representatives, in conjunction with representatives from the physician community, are working on proactive legislation to resolve several issues facing the ASC community and provide patients with [...]

Mass Health – Amendments to Surgery Regulations

April 20, 2011 – Effective April 1, 2011, MassHealth revised its regulations to payment for multiple surgeries performed on the same day and has developed new rules for global surgery periods. Under this new policy, payment for a surgical procedure includes a standard package of preoperative, intraoperative, and postoperative services.  The services included in the [...]

Cigna – Assistant Surgeons Policy

April 30, 2011 Modifier 80 – Assistant Surgeon Modifier 81 – Minimum assistant surgeon Modifier 82 – Assistant surgeon when qualified resident surgeon not available Physicians rendering services as an Assistant Surgeon (modifiers -80 & -82) will be reimbursed at 16% of the surgeon’s contracted rate or usual and customary or maximum reimbursable charge rather [...]

AETNA- Services Added to the national precertification list (NPL)

April 20, 2011 – Effective July 1, 2011, the following services will be added to the national precertification list: Endoscopy:  bronchoscopy, colonoscopy, upper gastrointestinal, cystoscopy, hysteroscopy Arthroscopy:  knee and shoulder Laparoscopic cholecystectomy Botox® type B Precertification approvals are valid for 6 months from the date of issue, unless stated otherwise at the time of precertification. [...]