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medical billing in ambulatory surgery centers

ASCs (ambulatory surgery centers) play a vital role and are essential in the healthcare industry –Why? ASCs are a cost-effective and convenient alternative to hospital-based procedures. With the increasing demand for ASC healthcare services, healthcare providers must adopt robust, comprehensive, and efficient medical billing in ambulatory surgery centers, as effective medical billing services are one of the best ways to ensure timely and accurate reimbursements.
Fact: The US ambulatory surgical centers market will likely expand at a CAGR of 6.5%. The market size of ASCs will reach USD 58.85 billion in 2028.

Understanding Medical Billing in Ambulatory Surgery Centers

What is Medical Billing in Ambulatory Surgery Centers?

Medical billing in ambulatory surgery centers presents medical claims to insurance providers and other payers for procedures conducted under ASC. It also includes the processes of confirming a patient’s eligibility and insurance coverage, in addition to submission of claims, tracking of outstanding claims, and even appealing for denied claims.
Medical billing in ambulatory surgery centers is complex and is subject to continuing changes. Furthermore, ASC healthcare billing necessitates extensive knowledge to ensure correct reimbursement processing. With the mounting operational expenses, decreasing revenues, and increasing patient responsibilities, healthcare centers cannot afford to chance any remuneration, thus giving rise to the need to establish precise and efficient billing practices.

Effective Practices for Medical Billing in Ambulatory Surgery Centers

  1. Accuracy in medical coding is one crucial element of the billing process. It drives the amount of reimbursement, which depends on the precision of the claim. Thus, it is essential that your ASC billing uses expert RCM professionals who are in line with the latest coding guidelines.
  2. Insurance coverage verification is another important step before moving on to other proceedings. Verifying patients’ insurance helps prevent any surprises for patients and ensures that correct claims are presented to payers. More often than not, healthcare IT solutions (software) are great in streamlining these processes as such systems support batch and real-time verifications.
  3. On-time claim submission is also important for reducing the probability of denied claims or even payment delays. Your billing staff or partner must have the requisite tools and resources for prompt claim submissions.  
  4. Timely and consistent follow-up on unpaid claims is vital for ensuring fast reimbursements. Furthermore, bringing in procedures to track outstanding claims and then devising a plan for timely follow-ups is the job half-done.
  5. Additionally, keeping updated on the new healthcare billing and coding regulations is also important. It becomes even more indispensable considering the frequent alterations of healthcare regulations. These regulations can directly affect medical billing in ambulatory surgery centers.

Key Differences of Physician Medical Billing with ASC Billing Services

Medical billing in ambulatory surgery centers differs from regular physician billing or healthcare facility billing. ASC billing necessitates adherence to specialized guidelines for reimbursements. Furthermore, ASC coding and billing are also independent of medical facilities. As the ASCs cater to every specialty in one place, their coding systems do not center on any specific type of services, diagnoses, or procedures.
Moreover, it doesn’t mean that your team will have to re-learn a new set of codes for ASC billing, or even new billing techniques. At the same time, what makes ASC billing massively different from hospital billing is billing the hospital codes via a CMS-1500 claim form, which is not a facility claim form.

Final Word

Understanding medical billing in ambulatory surgery centers is complex, as ASC billing is dynamic and intricate. Catering to the ASC billing services requires extensive knowledge to ensure proper reimbursements. The rising operational costs, mounting patient responsibilities, and declining revenues call for efficient employment and precise billing for ASCs. If you are on the lookout for healthcare billing, get in touch with our experts today!

Frequently Asked Questions

The ambulatory surgical centers bill surgical services, mainly for outpatient treatments. Some of these include the billing processes concerning pain management or even diagnostic procedures such as colonoscopies.
ASC (Ambulatory Surgical Centers) approved codes (HCPCS) and payment rates. These contain the procedural codes that can perform under an ASC Medicare program and the ASC payment group.
The CPT or Current Procedural Terminology codes give healthcare professionals and doctors a unified language for effectively coding medical services and procedures for streamlining reporting and increasing accuracy and efficiency.