4 Common Billing Mistakes ASCs Should Avoid
Ambulatory surgery centers can lose money and face compliance issues if they don't avoid these billing issues.
At the 20th Annual Ambulatory Surgery Centers Conference in Chicago on Oct. 25, Stephanie Ellis, RN, CPC, owner and president of Ellis Medical Consulting, identified some common billing errors that can cost surgery centers money and cause compliance problems. Here are just a few issues providers should address.
1. Make sure the form includes the correct place of service.
Providers should ensure the claim, at the beginning, clarifies that the service was performed at the ASC, Ms. Ellis said. This applies particularly if physicians are dictating forms from a hospital or their offices, she said.
2. Don't waive copays or deductibles in the absence of indigence.
Improperly applying "courtesy" discounts for patients who are supposed to pay deductibles or copays could result in getting cited for HIPAA violations, according to Ms. Ellis. She advised surgery centers to "be really careful with that."
3. Don't bill Medicare patients for procedures not covered in an ASC.
If Medicare won't pay for a patient to receive a particular service in an ASC but will cover it in another setting, the surgery center should send that person to a place where the procedure is covered, she said. Charging the patient cash for the service in the ASC qualifies as a Medicare violation.
4. Understand how to use modifiers correctly.
Using modifiers correctly on ASC claims is crucial, according to Ms. Ellis. Surgery centers use modifiers somewhat like hospitals do, although there are key differences. For instance, hospitals bill surgical CPT codes using the 360 code, while ASCs should use the 490 code, she said.
It's also important to pay attention to modifiers for bilateral and terminated procedures, she said. For instance, in most states, she said Medicare doesn't want providers to use the 50 modifier for bilateral procedures. Not having a clear understanding of this can lead to denied claims and ASCs getting underpaid, she said.
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