The healthcare industry plays a crucial role in our society. While it focuses on the care of patients, many financial aspects of it also need to be taken care of.
Every healthcare provider follows a procedure after having the patient in their facility, from the point of admission to the moment the patient is discharged.
In this blog, get your hands on the key strategies, critical steps, and best practices that ensures Ambulatory Surgery Centers receive proper reimbursement for the valuable surgical services they provide. From understanding the unique billing challenges in these outpatient centers to unraveling the intricacies of claims processing, equip yourself with the knowledge and insights necessary to navigate the world of ASC billing with confidence.
WHAT IS ASC BILLING?
ASC billing refers to the process of billing and obtaining reimbursement for the medical services provided by an Ambulatory Surgery Center (ASC).
ASCs are specialized healthcare facilities where surgical procedures are performed on an outpatient basis. These centers offer a wide range of surgical services, from minor procedures to more complex surgeries, all within a setting designed for efficiency and patient convenience.
WHY IS ASC BILLING IMPORTANT FOR AMBULATORY SURGERY CENTERS?
1. REVENUE GENERATION
2. FINANCIAL VIABILITY
3. PATIENT ACCESS
4. OPERATIONAL CONTINUITY
5. QUALITY OF CARE
6. COMPLIANCE AND REGULATORY OBLIGATIONS
7. PAYER RELATIONSHIPS
8. DATA ANALYSIS AND PLANNING
9. SUPPORTING HEALTHCARE PROVIDERS
10. CONTINUED GROWTH
WHAT IS THE ASC BILLING PROCESS?
Step 1: Patient Registration and Insurance Verification
This is the first and the most critical step in ASC billing. Herein, patient’s insurance details, demographic information, and other relevant details are collected and verified to ensure they are eligible for reimbursement.
Step 2: Procedure Documentation
Herein, the surgical procedures performed, including any additional services provided during the same visit (e.g., anesthesia, pathology) are accurately documented.
Step 3: Medical Coding
In this step of ASC billing, specific codes are assigned to the procedures performed using standardized coding systems like CPT (Current Procedural Terminology) codes. Accurate coding is vital for claim submission and reimbursement.
Step 4: Claim Creation
Herein, important information, including coded procedures, patient demographics, costs associated with the procedure, and other relevant information, is compiled to create a claim for the patient with details of the services provided.
Step 5: Claim Submission
Herein, claims are submitted to the related insurance companies or third-party payers electronically or manually. Timely submission of claims helps prevent delays in processing of the same.
Step 6: Claim Adjudication
In this step of the ASC billing process, the insurance companies review the submitted claims, evaluating the coding accuracy, medical necessity, and other factors. It helps in determining the reimbursement amount based on the patient’s insurance plan.
Step 7: Payment Posting
In this step, the ASC receives the appropriate payment once the claims are approved by the insurance companies. The billing team then posts these payments, reconciling them with the claims submitted to ensure proper reimbursement.
Step 8: Denial Management
If a claim is denied, the billing team investigates the reason for the denial. They take appropriate actions to appeal or rectify the issue, which may involve re-submitting the claim with additional documentation.
Step 9: Patient Billing and Collections
Herein, the billing team generates patient bills in case there are deductibles or copayments apart from the insurance coverage. They then communicate with patients to facilitate the payment. This step in ASC billing ensures that the ASC receives the revenue owed.
Step 10: Reporting and Analysis
Next, the data regarding claim denials, reimbursement rates, billing performance, and overall revenue cycle metrics are thoroughly analyzed to identify opportunities for process improvement, optimized revenue capture, and enhanced operational efficiency. After proper analysis, a report is generated to present all findings and suggest ways to improve the process efficiency.
Step 11: Compliance and Auditing
This step ensures that ASC billing practices comply with healthcare regulations, coding guidelines and payer policies. It is performed by conducting periodic audits to verify accuracy and adherence to industry standards, promoting ethical billing practices.
CHALLENGES IN AMBULATORY SURGERY CENTER BILLING & CODING
Complexity of the Procedure
Constant Regulatory Changes
Rate and coverage for every insurance company may vary, affecting the reimbursement rates for ASC procedures. Therefore, understanding each
payer’s specific requirements and staying up-to date on their policies is essential.
Claim Denials and Appeals
Coordination with Providers
WHY IS OUTSOURCING ASC BILLING THE BEST CHOICE?
Get Specialized Expertise
Outsourcing to a proficient and trustworthy ASC billing company helps in getting professional experts onboard in ASC-specific coding, billing regulations, and insurance processes. Your billing partner’s expertise ensures accurate coding, compliance, and reduced errors.
When you outsource your ASC billing to a billing company, there is a high chance of doing accurate billing, as their team of professionals has an in-depth understanding of ASC procedures and coding requirements.
Focus on Patient Care
By outsourcing ASC billing, healthcare providers or organizations can focus on providing quality treatments and other medical services to their patients.
Outsourcing ASC billing helps dedicate a team to the process and streamline the same, which ultimately results in faster claims processing, quicker reimbursement, and improved cash flow for the ASC.
Apart from hiring and training more staff, the healthcare provider or organization also needs to invest in software and maintain billing infrastructure. Outsourcing ASC billing can lead to substantial cost savings for ASCs.
Outsourced billing services can easily scale up or down based on the surgery center’s needs, accommodating changes in patient volume and supporting business growth.
Outsourcing ASC billing to reputable companies ensures that the billing process will be done considering the latest updates in healthcare regulations and compliance requirements.
Denial Management Expertise
Another significant benefit of outsourcing ASC billing is fewer denied claims and more appeal success. This is because outsourcing provides a dedicated team of professionals to work on the process, which allows effective management of claim denials.
Access to Advanced Technology
Billing companies leverage cutting-edge billing software and technology, improving the accuracy of coding, claim submission, and data security.
Time and Resource Savings
Outsourcing ASC billing not only helps save resources but also saves a lot of time, as the internal staff doesn’t have to indulge in the complexities of the process, and you don’t need to hire and train more staff.