Billing Principles for Ambulatory Surgical Center
An ASC is defined as a business that only provides outpatient surgical services to patients. A facility must be certified as satisfying the criteria for an ASC and inserted into a written contract with CMS to obtain coverage and payment for its offerings under this provision. In this article, we’ll go over the fundamentals of ASC medical billing. ASCs are classified into two types:
Independent: Not affiliated with any service provider or other facility.
Hospital: An ASC owned, licensed, or controlled by a hospital.
Payment inclusions
Nursing services, technical personnel services, and other related services: ASC nurses and technical staff provide all services with covered processes. Orderlies and other personnel provide patient safety.
The patient uses the following ASC facilities: Operation and maintenance and recovery rooms, patient preparation regions, waiting rooms, and other areas used by a patient or made available to the patient’s family members in connection with surgical services.
Drugs, biologics, surgical dressings, equipment, splints, casts, appliances, and machinery: All supplies and equipment are frequently provided by ASC in conjunction with surgical procedures. Exceptions include drugs and biologicals that cannot be self-administered. Protection for surgical dressings is restricted to primary dressings, which are refreshing and defensive coverings directly applied to skin lesions or open skin positions caused by surgical procedures. Ace bandages, elastic stockings and support hoses, Spence boots and other foot coverings, leotards, knee supports, surgical leggings, gauntlets, and pressure garments for arms and hands are all examples of secondary surfaces that are not covered as surgical dressings.
A doctor typically applies surgical dressings first and is coated as “incident to” a physician’s service in a doctor’s office: Such condiments are included in the facility’s offerings in the ASC setting. When a patient obtains surgical wound dressing from a supplier on a physician’s order, for example, a drugstore’s surgical dressing. The same policy applies to sauces acquired on a physician’s sequence after surgery in an ASC; dressings are protected and paid as a Part B provider by a local Part B contractor, which is included in facility services.
Diagnostic and therapeutic items and facilities: ASC personnel provide items and services in conjunction with covered medical procedures. ASCs perform simple tests before surgery, mainly urinalysis and blood hemoglobin or hematocrit, usually included within their facility charges. To the limited extent that such simple tests are also included in ASC facility charges, they are regarded as facility services; however, diagnostic tests are not enclosed in laboratories independent of a physician’s office, rural medical center, or hospital under the Medicare program unless laboratories demonstrate compliance for conditions for coverage of offerings of independent laboratories. As a result, diagnostic tests conducted by ASC that are not usually included in the facility’s charge are not wrapped under Part B as diagnostics. They are not charged to Medicare Administrative Contractor (MAC) as such.
· Anesthetic materials include the anesthetic itself and any equipment, whether disposable or reusable, required for its management.
· Intraocular lenses (IOLs): Surgically implanted devices, excluding those with OPPS pass-through. Dressings used during or following surgical procedures are included in facility fees.
· Items and services for administrative, record-keeping, and house cleaning: Items like planning, cleaning, utility companies, rent, etc.
Ancillary items and services
The following are examples of ancillary items and services that are required for a covered surgical operation, and in which completely separate payment to the ASC is permitted:
· Sources of Brachytherapy
· Certain surgically implanted items with OPPS pass-through status
· Specific items and services designated as contracting companies by CMS, including but not limited to corneal tissue sourcing
· Certain drugs, biological agents, and radiology services are eligible for separate payments under OPPS.
Not included in the facility
· Services provided by physicians
· Includes anesthesiologists’ services in prescribing or supervising anesthesia, the beneficiary’s healing from anesthesia, and routine pre-or post-operative services such as doctor’s visits, stitch withdrawal, dressing changes, etc.
· Durable Medical Equipment (DME) is sold, leased, or rented for home use.
· Devices for prosthetics.
· Prosthetics that are not implantable.
· Services for ambulances.
· Braces for the legs, arms, back, and neck.
· Legs, arms, and eyes made of plastic.
· Independent laboratory services.
Reimbursement
· The surgical procedures conducted in an ASC incur two high costs.
· Professional services provided by a physician to carry out the process.
· Service fees are charged by the facility where the procedure was conducted.
· The specialist fee is paid to the physician, and the ASC is reimbursed for facility expenses.
Claim submission
· Different line items, HCPCS Level II codes, or any other expense for processes, services, drugs, gadgets, or supplies bundled into the payment stipend for covered medical procedures must not be reported by ASCs.
· These other offerings or items are included in the surgical operation stipend. Additional objects and services, such as pass-through gadgets, brachytherapy sources, individually payable drugs, biological agents, and radiology processes, should be billed on the same claim as the linked ASC surgical procedure.
· Place of service (POS) 24 denotes an ASC, a freestanding facility other than a doctor’s office where ambulatory surgical and diagnostic services are available. Any support delivered by an ASC during a patient’s Part A Skilled Nursing Facility (SNF) stay is not compensated as a Part B claim.
· Under the Medicare Physician Fee Schedule, ASCs are obliged to report the TC modifier when billing for facility charges associated with HCPCS rules with both a technological and an expert component (MPFS).
Terminated surgical procedures
Payment has been made when a surgical procedure is ended due to the patient experiencing health complications that would put people at risk if the process was continued. ASC claims involving a cancelled surgery must be accompanied by an operative report containing all the information listed below:
· Reason for surgery termination.
· Services rendered description.
· Summary of provided supplies.
· Services that would have been provided if surgery had not been postponed.
· Supplies that would have been supplied if the surgery had not been cancelled.
· The amount of time is spent in each stage (e.g., pre-op, operative, post-op).
· The amount of time would have been expended in each of these stages if the surgery had not been stopped.
· CPT codes for processes scheduled to be conducted.
Terminated processes are linked to two modifiers:
Modifier 73: The procedure was terminated before the administration of anesthesia.
Modifier 74: The procedure was terminated following the administration of anesthesia.
Modifier 53 is only for physicians and is not used by ASCs.
We hope this article has covered the fundamentals of ASC billing. Billing executive services can provide comprehensive ASC billing and coding services. Our precise and cost-effective ASC billing services will reduce billing and coding mistakes while increasing insurance collection. To learn more about our ASC medical billing and coding services, please get in touch with us at rcmexpertz@gmail.com
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