ASC Multi Specialty Billing
Multi-specialty ASCs represent nearly half of all surgery centers (SDI’s 2008 Outpatient Surgery Center Market Report). The flexibility and economies of scale achieved by having multiple specialties under one roof offset the additional complexity and costs. Medicare’s ongoing addition of procedures it will reimburse in an ASC setting continues to accelerate multi-specialty growth. Changes in Medicare reimbursement by specialty have caused some centers to increase more profitable cases, such as orthopedics, by recruiting additional surgeons. Plus ongoing improvements in technology and anesthesia continue to drive overall ASC growth. And patients are increasingly receptive to outpatient multi-specialty procedures as they find the environment of an ASC more attractive than many hospital settings.
Skills required for Multi-specialty ASC Billing
Billing for ASC multi-specialty procedures can be complex. Multiple specialties, by definition, mean a wide variety of procedures and underlying causes (diagnoses). Often rules vary by payer (e.g. modifiers). As a result, it is recommended that only experienced multi-specialty coding and billing staff be employed. To perform effectively, billing staff must be knowledgeable in coding, charge posting, claims filing, payment posting, customer service, A/R follow-up including denial management, and reporting.
For many centers, finding and retaining these skills in a relatively small staff can be a challenge. For this reason, hiring a firm who specializes in multi-specialty ASC billing may be the best option. The right firm offers an ASC the ability to hire a team of experts, specialized and skilled in each of the billing disciplines, while only paying for a fraction of the costs. Since a professional ASC billing company performs coding and billing for many ASC’s, economies of scale are realized and passed along to clients. The volume of work justifies having specialists and experts and avoids the risk that an ASC faces with internal staffing: “jack of all trades, but master of none.”
Multi specialty ASC Billing Considerations
Insurance underpayments are an issue for all specialties, but they can be particularly common, and troublesome, for ASCs with substantial volumes of general surgery. Underpayments can represent 5%, 10% or more or a surgery center’s revenue. Capturing all of the supplies used and assuring that they are reimbursed, where allowed, is one example.
As everyone knows, coding rules are constantly changing. The addition of new procedures (and their associated codes) is important. However, careful coding of common procedures is equally important. Many centers perform a certain number of procedures that can be performed in an office setting (e.g. hemorrhoid treatments) for both patient and surgeon convenience.
In all of these cases, it is critical that coders carefully review the operative note to make sure they’ve accurately and completely captured exactly what was done. In some cases, multiple procedures are performed in one operative session. And coders must assure that HCPCS and CPT codes are not only accurate but also consistent.
Patient billing is also complex for multi-specialty ASCs. Procedures can be perceived to be expensive, and payor explanations are often confusing to patients. These factors plus bills from other specialists (e.g. the anesthesiologist) often lead to confusion. Billing staff and procedures built to offset these perceptions can be much more successful in collecting patient balances in a timely manner.