Ambulatory Surgery Center (ASC) coding services are an essential way to help surgery centers thrive. Without implementing a seamless process, poor coding management threatens profitability. According to research, one in four claims are denied, reducing the lead time for collection. In order to mitigate this risk, ASC coding solutions should be used in surgery centers. Explore below the 5 ways that utilizing ambulatory billing and coding services can add immediate value to outpatient surgical centers below.
Coding for ASCs is not simple. For Medicare, surgery centers are required to send their bills to Part B payers but using the claim form for Part A. Similar complexity can be found with private payers. The coding rules for ASCs can vary contextually, requiring staff to understand not only the regulatory requirements but also the specific circumstances of each case.
Furthermore, a simple incorrect modifier can lead to a denial. Often surgeons are unaware of
bundling rules and new or updated coding guidelines.
Working with a coding service that specializes in ASCs can make all the difference. This can greatly improve compliance and reduce the likelihood of claims denials and unrealized revenue.
Another key challenge for ASCs is the varying rules for different insurance carriers. A specialized ACS service can ensure that those rules are closely understood and followed to have claims paid faster.
Research suggests that about a quarter of a typical ASC’s revenue is applied to salaries and wages. So, even modest savings in labor can have a significant impact on the bottom line.
ASC coding can make a huge difference. Getting a claim right the first time can substantially reduce the time needed to earn revenue for a procedure. Appeals are very costly and only have about a 50% success rate.
Additionally, high-quality revenue cycle management can help to automate more of the coding for your surgery center. This means that the labor costs for every claim will be reduced. If you add that to fewer claims going to appeals, you have substantial cost savings.
Healthcare regulations can also be a dense web of interrelated and sometimes seemingly contradictory federal, state and local rules. The cost of infractions can be substantial. In some cases, the U.S. Department of Health and Human Services has required surgery centers to pay back Medicare due to coding non-compliance. This is on top of the steep legal fees necessary to argue against such a judgment.
While it is never possible to completely eliminate legal exposure, taking steps to implement coding best practices, and working with reliable services can aid in averting legal liability. Additionally, having evidence of taking coding compliance seriously will mitigate the cost of an adverse judgment (by making it clear that steps were taken to avoid the error). The right surgery center coding service can help significantly with both sides of avoiding legal costs.
Finally, it is always beneficial to establish an auditing cadence for your coding and revenue cycle activities. Regulatory requirements change frequently and can have a big impact. For example, the 2015 requirement to switch to ICD-10 cost some surgery centers millions to ensure compliance.
In short, working with an ASC coding service that will audit processes and find inefficiencies can be very beneficial. Sometimes benchmarking against industry best practices and norms can make all the difference in guaranteeing your ASC is running profitably.
abeo offers coding services that assist in realizing all the above value-adding benefits. We have specialized offerings to support Surgery Centers with their RCM, coding, and auditing needs. Let’s connect to discuss our quality ASC amenities and how we can be of service to you.
abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.