Ambulatory Surgical Centers (ASC) are outpatient surgical centers not requiring patient hospitalization or the procedure duration does not exceed 24 hours from the time of admission. ASCs are standalone centers as CMS regulatory does not allow ASC and other medical entities such as a medical practice or physician office to operate in one common space unless under certain conditions. As a distinct entity exclusive for outpatient surgical services, ASC must sign a written agreement with Center for Medicare and Medicaid Services (CMS) and be certified and approved by CMS as participating providers.
ASC Billing and Coding Guidelines – an Overview
ASC services are billed on a combination of Hospital and physician billing form CMS 1500 for Medicare part B and some third-party carriers, while other payors and commercial insurance require UB04 for billing ASC claims.
ASC services are coded using HCPCS Level II codes along with ICD -10 CM in certain instances as allowed by the payors.
Latest Update – ASC Payment System
Effective 1st January 2021, CMS has updated various changes in the payment system and policies for ASCs. In the previous update for ASC in 2019 CMS included “surgery like” procedures outside the CPT surgical codes that meet required criteria to be on the ASC list. Now with effect of the current payment changes in enrollment, utilization, case-mix changes, ASC Medicare payments for 2021 is expected to see an increase of $120 million approximately. Let us have a broad look into some ASC new and revised code changes
- HCPCS code C9053, which was effective April 1, 2020, was deleted June 30, 2020 and replaced with HCPCS code J0791 (Injection, crizanlizumab-tmca, 5 mg) effective July 1, 2020.[1]
- HCPCS code C9056, which was effective April 1, 2020, was deleted June 30, 2020 and replaced with HCPCS code J0223 (Injection, givosiran, 0.5 mg) effective July 1, 2020[1].
- HCPCS code C9057, which was effective April 1, 2020, was deleted June 30, 2020 and replaced with HCPCS code J1201 (Injection, cetirizine hydrochloride, 0.5 mg) effective July 1, 2020.[1]
- HCPCS code C9058, which was effective April 1, 2020, was deleted June 30, 2020 and replaced with HCPCS code Q5120 (Injection, pegfilgrastim-bmez, biosimilar, (Ziextenzo), 0.5 mg) effective July 1, 2020[1].
- HCPCS code C9754, which was effective January 1, 2019, was deleted June 30, 2020 and replaced withHCPCS code G2170 effective July 1, 2020.[1]
- HCPCS code C9755, which was effective January 1, 2019, was deleted June 30, 2020 and replaced withHCPCS code G2171 effective July 1, 2020.[1]
- HCPCS codes Q4227 through Q4248: The availability of an HCPCS code for a particular human cell, tissue, or cellular or tissue-based product (HCT/P) does not mean that that product is appropriately regulated solely under section 361 of the PHS Act and the FDA regulations in 21 CFR Part 1271.[1]
Strategies to Improve KPIs in Your ASC Billing
Billing for ASC requires you to understand the ASC setup and its operating conditions under CMS regulatory. Going through the above overview and latest changes will ease understanding billing and coding guidelines for ASC Billing. Having a streamlined billing process in place will optimize the overall billing experience and result in improved revenue cycle management for Ambulatory Surgery Billing.
Effectively monitor and measure KPIs to Improve
By closely monitoring key performance indicators (KPI) and tracking them will help identify lags, default in the process and streamline them. Have a checklist of KPIs as below to be tracked and monitored regularly for consistent and improvised results.
- Closely monitor each claim and track its average bill days to ensure each and every claim is billed within the timely filing limit (TFL) and paid appropriately. Unwanted delays in billing will lead to claim denial, lost or reduced pay.
- Have a track on the payment days of each insurance payer. Each insurance will have different payment days from the claim submission date, tracking it will help you understand the payment process and schedule follow-up if required.
- Tracking Old AR aging more than 90 days will help decrease your revenue loss and maintain a healthy billing process. It is ideal to make sure that your old AR does not cross more than 10-15%. Anything exceeding this can be a sign that your billing is overlooked and needs immediate attention and corrective measures for effective and productive results.
- Keeping a track of the denial reason and educating your billing and coding staff on repeated errors to reduce denial percentage.
Outsourcing your ASC billing to an offshore-based Medical Billing company can help enhance your billing process and your monthly collections.
About e-Care India
e-Care is one of the top medical billing companies in India with more than 20 years of experience in the industry, e-Care provides end to end billing services to more than 100+ Clients across US. e-Care is a multispecialty medical billing company having expertise across more than 28 specialties. Our team has a clear understanding of the payer guidelines for ASC billing in various states. To know more about our ASC billing visit Ambulatory Surgical Center (ASC) Billing Services | e-care India
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