Ambulatory Surgical Center
Distinguishing Factors in Our ASC Billing Services
Unlike FSEC, who are linked with hospitals, Ambulatory Surgical Centers (ASCs) are stand alone, privately owned (mostly by physicians) centers offering same day outpatient surgical procedures. But that what hospitals outpatient services do, right! The difference is that ASCs offer lower cost due to lower in size and less overheads, offer same quality of service, have state of the art equipment and specialised doctors, smaller chance of infection, and less stressful environment whereas hospital outpatient take on more complex surgeries where more intense post operative care is needed with diagnostic services availability such as lab test etc. MTServices ensures training and education for its team on ASC (Ambulatory Surgical Centers) before initing a medical billing cycle. Our ASCs billing team is understand that ASCs exclusively provide outpatient surgical services on preventive and diagnostic level, excluding laboratory services, and diagnostic tests. Given that ASC coding involves a blend of institutional and professional services, MTServices staff undergoes thorough training in the utilisation of HCPCS Level I and Level II codes.
Current Trends in the ASC Industry
With rising healthcare cost in US, Ambulatory Surgical Centers (ASCs) are cost effective solution. They offer 50 to 55% savings on the procedure done in hospitals with same quality of services provided with added benefits such as personalised, quick, less hectic environment. This bring savings to third party insurances, government and patient with the amount topping up to USD 2.5 Billion each year. Given all that ASCs market size is expected to grow from USD 38.6 Billion to USD 40.4 Billion by 2023 and USD 58.85 billion by 2028 with CAGR of 6.9%. Even with all these positive figures, the ASCs are not without impending issues and one of the reason is their financial viability. For example, since ASCs can offer savings, the payment structure to them are bundled by center of medicare and medicaid (CMS). In 2003 CMS paid 16% less on average to ASC but now this disparity has raised to 82% and on top of that there is no health or fiscal policy to explain such disparities compared to hospital outpatient (HOPD). Reimbursement remains a significant barrier for Ambulatory Surgical Centers.
Ambulatory Surgical Centers Medicare Payment increase, HCPCS codes, Payments
Medicare Part B plan has a temporary payment increase for some biosimilar Biological products as per inflation reduction Act (2022) using Medicare Average Sales Price Payment Methodology from average sales price (ASP). The key points for temporary payment increase Medicare specific HCPCS codes and payments are:
- Temporary price increase is 6 percent to ASP plus 8 percent of the ASP of the reference biological.
- Increase is for 5 years only with starting time, depending on the time when payment was first made. It could be either the 1st of October/2022 or first day of calendar.
- The system for payment or Outpatient Prospective payment system (OPPS) and Ambulatory Surgical Center payment systems generally use the Medicare Average Sales Price Payment Methodology for biosimilars.
- Medicare approved procedure codes for ASCs as well as it's payment group for procedures.
- Payments by Medicare are determined based on ASC payment group for the covered procedures.
- The CMS offers bundled payment models to reduce rising medical costs throughout the health care industry. A standalone ASC is paid one fee for the procedure performed, no matter the cost to the center.
Efficient ASC Billing and Revenue Cycle Management
With complete awareness of ASCs, their operations, services offered, Medicare approved procedure codes, and understanding of payment group with realisation of key difference with HOPD, our billing team effectively address the Revenue cycle for ASC. Our preemptive NO-DENIAL approach instill error-free claim submissions, lesser denials and follow ups. Based on knowledge and experience, we establish ourselves as a professional and comprehensive solutions provider for Ambulatory Surgical Centers (ASCs). The billing team assigned to ASCs remains well-informed about upcoming updates in ASC coding guidelines, utilising cutting-edge software solutions to deliver optimal performance.
Although mainly ASCs are independent standalone, but there are ASCs part of hospitals (licensed or under hospital control) and MTServices deals with both types of ASCs billings. ASCs billing is a specialised task as they are regulated by federal as well as state level regulations, statue are require HIPPA compliance. Our team with the complete knowledge of ASC's documentation and coding guidelines, such as ASCs related use of modifiers, the place of service identifier, specific medicare CPT and HCPCS Level II codes makes ASCs Revenue cycle shorter with good health of A/Rs.
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