Author Topic: ASC Billing- How to?  (Read 2752 times)

lindsayk

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ASC Billing- How to?
« on: May 24, 2011, 12:12:40 PM »
I am new to UBO4 billing and am billing for an ambulatory surgical center.  Just wondering if we are only allowed to bill 490 for the actual procedures rendered or if we can also be billing seperately for items like implant, plates & screws, or items such as prophylactic medications administered, recovery room time, or surgical supplies used.  I guess an example would be...a fracture which was fixed, but the patient was given IBUProfen and prophylactic antibiotics before surgery.  The surgery was performed using plates and screws, and then the pt was taken to recovery and discharged from there.  Can you give me any insite as to what items can all be billed and what types of rev codes would be used other then the 490?  Any info is helpful.

Michele

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Re: ASC Billing- How to?
« Reply #1 on: May 25, 2011, 07:14:51 AM »
You should look thru the list of rev codes to see what ones apply to the services being provided.  Also, how does the ambulatory surgical center charge?  By procedure?  A Global Fee?  Or for each thing provided? Does the surgery center provide the plates and screws or is that the surgeon?  Do the surgeons work for the ambulatory surgery center or are they separate?  Lots of questions, but there are rev codes for the things you've described.  For example, 710 or 719 is the rev code for recovery room.
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lindsayk

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Re: ASC Billing- How to?
« Reply #2 on: May 25, 2011, 01:18:06 PM »
The facility currently bills for each procedure, but hasn't been billing for items like recovery or plates & screws, or pharmacy items.  I guess that is part of my question too, is what is allowed to be billed and what is the best way.  The surgeons do work for the facility and so the facility is supplying these extra items.  Does that answer your questions to help you help me answer mine?   :)

Michele

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Re: ASC Billing- How to?
« Reply #3 on: May 31, 2011, 06:46:00 AM »
The facility can bill for everything that is supplied/provided.  Not all insurance carriers will reimburse all items.  Some may consider them inclusive.  But all should be billed.  For example, many in office surgeries will bill separately for the surgical tray but most insurance carriers consider that part of the surgery and don't reimburse separately.  Now the facility has to determine if their fee for the facility includes items like screws etc, or if they are going to break it out and bill separately.
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lindsayk

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Re: ASC Billing- How to?
« Reply #4 on: June 03, 2011, 08:33:50 AM »
As far as splitting up the items and billing seperately, is there one way or another that you would recommend that insurance carriers typically process better?

Michele

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Re: ASC Billing- How to?
« Reply #5 on: June 03, 2011, 09:41:43 AM »
Insurance companies vary.  Each will like it their own way.  The ASC needs to decide how to bill and then adjust to each insurance carrier's requirements.

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tlewis

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Re: ASC Billing- How to?
« Reply #6 on: June 13, 2011, 05:09:42 PM »
what kind of ASC are you billing for? Freestanding or Hospital owned? Also what state are you billing for? I bill for a freestanding ASC in Oregon, we do not bill on UB04 we are very limited on what implants, drugs ect we can bill for. Also I do not agree with the "you should bill for everything" if you are billing for items to medicare that clearly state that are included with the procedure you are flagging yourself for an audit. This is my bible.

http://www.medicarenhic.com/providers/pubs/Ambulatory%20Surgery%20Center%20Billing%20Guide.pdf
Also insurance companies are now following CMS guidedlines stating that the implant is included with the payment so they will no longer reimburse implants not on pass through status with CMS.