ASC Billing Services

Facility fee claims, the covered procedures list, implant reporting and multiple procedure discounting.

An ambulatory surgery centre is paid on its own fee schedule, for its own list of covered procedures. None of that follows the surgeon claim. A procedure payable in a hospital may not be payable in an ASC at all. Bill it anyway and you get a denial the surgeon never sees. Our ASC billing services check the covered procedures list before the case is booked. Not after it is billed.

Centres should also treat ASC credentialing as a facility project, not a paperwork task. State licensure, accreditation and a CMS Certification Number all come before any facility fee is payable. And every surgeon who operates there is privileged by the centre, separately from any payer contract.

Our Services

Why ASC Billing Is Different

Of all the specialties we bill, ambulatory surgery centres are among the most complicated. They are also among the ones we know best.

ASCs handle same-day surgery, including keyhole and laparoscopic work. Your centre moves quickly, so the billing has to as well. We keep collections moving within a few days, and often on the same day.

What benefits do our ASC Coding and Billing Services provide for you?

  • HIPAA-Compliance

    Cure CloudMed adheres to the Health Insurance Portability and Accountability Act. It's not only sufficient to state that we comply with every regulated billing protocol, but we also follow them with utmost dedication.

    Transparency icon

  • Transparency

    We greatly appreciate collaborative decision-making, and we actively engage in it with equal enthusiasm. It's your practice, and our suggestions are geared towards what's best for you and your practice. The ultimate authority lies in your decisions.

    Procedure icon

Procedure

Proficient expertise in medical coding and billing for Ambulatory Surgery Centers:

  • Plastic
  • Orthopedics
  • GI
  • Urology
  • Ophthalmology
  • Pain Management

How an ASC claim differs from a hospital one

Ambulatory surgery centre billing looks like hospital outpatient billing and is paid on a different system, with a different list of what is covered.

The covered procedures list

Medicare pays an ASC only for procedures on its ASC covered procedures list, which is updated every year. A procedure that is payable in a hospital outpatient department is not automatically payable in a surgery centre. Scheduling a case that is not on the list, or that a commercial payer restricts to a hospital setting, produces a denial that cannot be appealed on clinical grounds because the issue is the site of service.

Checking the list and the payer's own site of service policy belongs at scheduling, not at billing. By the time the claim denies, the case is done and the cost is spent.

Facility and professional are separate

The centre bills the facility fee. The surgeon and the anaesthesia provider bill their own professional services separately. Three claims describe one operation, and when they disagree on the procedure, the date or the laterality, all three get reviewed. Reconciling them before they go out is the single highest value control in an ASC.

Packaged payment

The ASC payment for a procedure includes most of what goes with it: the supplies, the drugs, the anaesthesia materials, the equipment. Billing those separately does not add revenue, it adds edits. A small number of items, including certain implants and some drugs, are paid in addition, and knowing which is the difference between a correct claim and a write off.

Implants in particular need the invoice attached to the process rather than filed away, because several payers pay them at cost plus a percentage and will not pay at all without it.

Multiple procedures

When more than one procedure is performed in the same session, payment is reduced for the additional ones under a standard reduction. That is expected and correct. What is not correct is the centre's contracted rate being applied as if each procedure stood alone, which is how ASCs end up with receivables that never reconcile.

ASC Credentialing: Facility Enrollment and Surgeon Privileges

An ambulatory surgery center is credentialed twice, and the two jobs are separate. The facility enrols with Medicare as an ASC. That needs a state license, a survey, and in practice accreditation by an approved body such as AAAHC, The Joint Commission or QUAD A. Only then does a CMS Certification Number exist, and only then are facility fees payable. Each commercial payer and each Medicaid managed care plan then contracts the center on its own.

Every surgeon who operates there is a separate matter again. The center$1s own governing body credentials and privileges them. That is not the same as being contracted with the payers the center bills. An out-of-network surgeon operating at an in-network facility is how split claims and angry patients happen.

We run the facility enrollment and the surgeon roster together. See our medical credentialing services.