Author Topic: ASC Queries  (Read 1415 times)

Anand

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ASC Queries
« on: September 26, 2014, 08:24:00 AM »
I am pretty new to the ASC billing and am in the process of learning things before I start things officially. I understand that ASC are outpt surgical center and do not require hospitalization and of-course you got to be adding SG modifier to say that you are billing of hospital set-up & services.

(i) Is it correct that for ASC there could be two billing - Facility and for professional - and all professional got to be billed under CMS-1500?
that is irrespective of payers, I am also unsure if how does it varies from Commercial vs Medicare/Medicaid -- does the commercial got to be billed in UB and MCR/Medicaid to be under UB04?

or

(ii) When I bill the facility alone I got to use UB 04 across all payers....

I am planning to get the 855I done but we would handle the complete billing so should I get the 855A.. can someone shed some light..

If any link that I can for education purpose do share it as well.

Thanks

Michele

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Re: ASC Queries
« Reply #1 on: September 26, 2014, 09:05:42 AM »


(i) Is it correct that for ASC there could be two billing - Facility and for professional - and all professional got to be billed under CMS-1500?
that is irrespective of payers, I am also unsure if how does it varies from Commercial vs Medicare/Medicaid -- does the commercial got to be billed in UB and MCR/Medicaid to be under UB04?


Yes, the actual facility charges for the ASC (use of the facility) are billed on a UB04 for all payers.  The professional charges (surgeon, assistant surgeon, anesthesia, etc) are billed using the CMS 1500.  This is the same as if done in a hospital.


or

(ii) When I bill the facility alone I got to use UB 04 across all payers....

I am planning to get the 855I done but we would handle the complete billing so should I get the 855A.. can someone shed some light..

If any link that I can for education purpose do share it as well.

Thanks


If you are enrolling the ASC in Medicare then that is done on the CMS 855A.  I think the problem is that you are getting the physicians and the surgery center blurred into one.  Even if the surgery center is owned by a physician, the surgery center must be treated separately from the physician.  The surgery center must enroll with insurances as a surgery center and the physician must enroll as a physician.

Hope that helps.
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