Ambulatory surgery centers can lose money and face compliance issues if they don't avoid these billing issues.
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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