What is ASC ﴾Ambulatory Surgery Center﴿ Billing and Coding? Home / Billing / Blog / ... / What is ASC ﴾Ambulatory Surgery Center﴿ Billing and Coding? Posted on July 6, 2023 | By Simon | In Billing , Blog , Coding | Leave a comment Several federal and state regulations and statutes govern the billing practices of ambulatory surgery centers ﴾also known as ASCs﴿. The rules that regulate ASCs outline every aspect of them, including their daily operations and compensation. Most patients at the ASCs are Medicare beneficiaries, so the facility must adhere to Medicare’s standards and regulations. ASCs must also consistently comply with other requirements, like HIPPA ﴾Health Insurance Portability and Accountability Act﴿. For most outpatient surgical operations, ASCs normally submit claims using CPT and HCPCS Level II codes. However, some private insurers may permit ASCs to use ICD codes for compensation. Today’s post is all about ASCs. From answering what an ASC is to discussing ASC coding and billing tips, this post has it all for you. So, keep reading to learn about ASC billing and coding. What is an ASC? Patients frequently have the question, what is an ASC, and what should they know about it? Even after going to an ASC, many people are unaware that they have seen their physician at an ASC. They are also unaware of the benefits that the ASC has provided to them due to their visit there. So, here is the answer to the question: what is an ASC? ASC, or ambulatory surgery center, is a licensed outpatient surgical facility. People cannot travel long distances or wait several weeks for hospital or doctor’s office appointments. ASC are facilities where individuals can undergo surgery outside of a hospital setting. Formerly affiliated with hospitals, most ASCs are now independent clinics where patients can receive surgery and other outpatient services. If a patient is healthy enough to have elective surgery, their physician Facebook Twitter LinkedIn may recommend that the procedure be performed in an outpatient surgical facility. Most patients undergoing surgery at an ASC are in good health and can return home the same day. This allows them to recover at home, where they are most at ease. Reasons to select an ASC over a hospital for elective surgery or invasive treatments include the following: Less out‐of‐pocket expenses or lower costs Less wastage in medical supply consumption Reduced likelihood of developing an infection after surgery ASC Coding and Billing This section sheds light on what ASC billing is and how it differs from traditional medical billing. ASC billing differs significantly from billing for traditional doctors or hospitals. ASC coding and billing is not centered on a particular medical specialty, unlike physician medical billing, which must adhere to a few very strict regulations to be reimbursed. The ASC coding system does not prioritize specific services, operations, or diseases. The procedure for submitting a claim uses the CMS500 template. This is a substantial difference compared to hospital billing and coding. ASCs can only serve patients diagnosed by a primary care physician and require medically essential operations. ASCs must adhere to this guideline to be compensated for their services. CPT and ICD Codes for ASC Billing ASCs employ codes from CPT and ICD‐10‐CM to diagnose patients, perform procedures, prescribe drugs, and describe medical devices. However, ASCs will be required to apply the most recent ICD‐11 modifications to diagnose patients as soon as they become effective. ASCs are not compelled to use C‐Codes for invoicing Medicare, unlike outpatient settings. On the other hand, Medicare’s coverage of medical equipment and pharmaceuticals is governed by a distinct set of laws and regulations. ASCs should not use the HCPCS II code set for medical equipment and pharmaceuticals when billing Medicare. Each device or medication used must be separately recorded and billed. It might be challenging to code and document all of the services delivered to patients at an ASC. ASC Billing Guidelines ASC billing guidelines are set by CMS ﴾Centers for Medicare and Medicaid Services﴿ to make sure that ASCs are billing correctly and in compliance with regulations. These guidelines cover a wide range of topics, including the types of procedures and services that can be billed, how to bill for those procedures and services, and how to document patient information properly. For example, ASCs can only bill for procedures deemed appropriate for an outpatient setting and must provide adequate documentation to support the services provided. Additionally, ASCs must follow specific coding guidelines, such as using the correct HCPCS and CPT codes and submitting claims promptly. ASCs that fail to comply with these guidelines may face the consequences, such as denied claims or fines. ASC’s billing department needs to stay updated on any changes to the codes and regulations to ensure compliance and minimize denied claims. What is an ASC Payment System? Medicare covers all outpatient treatments an ASC provides, and the program’s payment classification structure is simple. Any Medicare‐covered service has its unique CPT code, and its weighting is comparable to any other outpatient operation. Then, these codes are transformed into a regular flat payment using the various ASC conversion factors. Each claim may cover multiple outpatient procedures so long as they meet the same requirements. Imaging and additional treatments may also be covered if they are essential components of the primary operation. However, these additional procedure fees are not billed separately. Instead, they get compensated in one lump sum for each claim. This is because both are considered components of the same service. Additionally, when many operations are invoiced under the same claim, each procedure is not compensated at the same rate. This is because the insurer treats several procedures as a single claim. In such cases, the Multiple Procedure Reduction policy is implemented. This policy states that the first procedure will be reimbursed at the full permissible rate, but future treatments will only be reimbursed at half the normal rate. See Also: Guide to Medical Billing and Coding Best Practices Conclusion Understanding what an ASC is with its billing and coding guides is crucial. ASC billing is a specialized process used by Ambulatory Surgery Centers to bill for patient services. It involves using HCPCS and CPT codes and submitting claims to insurance companies for reimbursement. A thorough understanding of the specifics of ASC billing is vital for ASCs to ensure they are getting paid accurately and on time. ASC’s billing department needs to stay updated on any code and regulation changes to ensure compliance and minimize denied claims. Do not let ASC billing and coding keep you from focusing on patient care. Let Precision Hub handle all of your billing and coding needs. Contact us to learn more about our comprehensive services and see how we can streamline your practice’s revenue cycle. asc billing asc coding what is an asc Simon My name is Simon and I hold a PhD in Medical Sciences. I bring to Precision Hub my seven years of exposure. As a medical writer, I have contributed to industries as vast as medical devices & med‐tech, pharmaceuticals, healthcare agencies, hospitals, health tech firms and healthcare communication agencies. Recommended Posts Systematically Decrease Your Accounts Receivable Previous No comment yet, add your voice below! Add a Comment Your email address will not be published. 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