If your physician’s office of ambulatory surgery center (ASC) offers outpatient procedures, it’s important to understand HCPCS codes for all services rendered. If you’re in the dark regarding ambulatory surgery center billing, your clinic could be leaving money on the table.

Even experienced physicians can run into trouble when filing ASC claims for the cost of patient care. Many payers, especially Medicare, frequently change procedure codes and payment rates for ASC services.

A practice management system such as Weave may not be able to handle HCPCS Level II codes for you. Still, it can help you streamline billing to make your life as an ambulatory surgical center provider easier.

Understanding Ambulatory Surgery Center Billing

To understand billing for ambulatory surgical centers, it’s important to know what an ASC is. An ASC is a facility that performs outpatient services that don’t require a hospital stay for patients. That includes minimally invasive surgery, such as laparoscopic surgery.

Performing a heart transplant, reattaching a severed limb, or conducting surgery to treat a life-threatening condition may not qualify as ASC services because patients usually need to stay overnight after such procedures.

Key Components of ASC Billing

Providers must know the correct ICD-10-CM, HCPCS Level II, and Current Procedural Terminology (CPT) code to seek reimbursement for services performed for each ASC procedure. Once providers submit a claim for a procedure, Medicare uses unique ASC conversion factors to translate the codes to standard flat payment rates.

Each claim can cover multiple procedures in an ASC setting, including ancillary services, such as applying surgical dressings or giving a patient anesthesia. Additional procedures safely performed during surgery can receive coverage as well. Medicare packages all separate line items into a single system per claim.

The Role of Medicare in ASC Billing

Under Medicare coding guidelines for bill payments, a physician must not report each procedure performed for a patient as a separate line item on their surgical procedure bill. All services, devices, and supplies are packaged into a payment allowance for approved procedures.

However, it’s important to note that CMS allows individual coding and billing for biologicals and take-home medications that can be paid separately.

Medicare has announced updated payment rates for ASC provider and hospital outpatient services in 2024. These changes include the following:

  • Updates to payment policies
  • Updates to ASC quality reporting programs
  • Changes to hospital price transparency requirements, which require hospitals to clarify what the facility charges for services and procedures

Best Practices for ASC Documentation and Coding

Using the wrong HCPCS code or SG modifier for services performed and billed can cost an ASC a lot of money. Here’s how to keep up and ensure you receive payment from Medicare for devices, supplies, anesthesia, and other surgical procedures performed.

Staying Updated With Coding Guidelines

CMS publishes updated guidelines to ASC codes annually. Updates may include discontinued procedures, changes to device-intensive procedures, or alterations to surgical procedure code.

Implementing Quality Reporting Measures

An ASC must comply with CMS pre-determined quality reporting guidelines for each surgical procedure a physician wants to bill. If an ASC or physician fails to meet program requirements, CMS penalizes them with a 2% point reduction in payment for any service or procedure billed.

Challenges in ASC Billing and How To Overcome Them

Claim denials and underpayments are two of the biggest issues for your ASC. To avoid them, you must know the proper coding for each service and procedure. There’s a technical component to figuring out the right code to bill for surgical procedures. If you’re unsure, you may want to pay a third-party claims management company to help your ASC.

Utilizing Technology for Efficient Billing

Collecting the full cost of every procedure billed is quite challenging. If you’re having trouble collecting payment from Medicare for a colonoscopy, laparoscopy, or other procedure, consider a practice management system such as Weave.

Weave eliminates the headache of collecting payment for a procedure. Simply text or email your payment request, allowing patients to pay you from any device.

Weave Streamlines Billing for Ambulatory Surgical Centers

Ambulatory surgery center billing can be incredibly complex, but Weave can make coding and collecting payments for services and procedures a bit easier. Get your demo and learn how Weave can help you as an ASC physician today.

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