ASC Specialty Billing Services

ASCs comprise a wide variety of specialties, reflecting ongoing advances in surgical technology (e.g. laproscopy, micro instruments, etc.) and anesthesia. Medicare’s steady addition of procedures reimbursed in an ASC setting has accelerated ASC growth. Ongoing changes in Medicare reimbursement by specialty reflect both challenges and opportunities for well-managed surgery centers. Also, patients are increasingly receptive to specialty outpatient procedures as they find the environment of an ASC more attractive than many hospital settings.

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Skills required for specialty ASC Billing

Billing for specialty surgery center procedures can be complex. Smaller specialties can mean limited coding and billing experience or staff, despite a wide variety of procedures and underlying causes (diagnoses). Often rules vary by payer (e.g. modifiers). It is recommended that only experienced 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 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.”

Specialty ASC Billing Considerations

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.

Insurance underpayments are an issue for all specialties and 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.

Patient billing is also complex for 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.