There are many benefits to ambulatory surgical centers, but unfortunately, freedom from the hassles of medical billing isn’t one of them. Like any other medical care provider, surgical centers have to deal with the extensive coding system and the various requirements of different payers and insurers.
Outsourcing medical billing and coding has brought tremendous relief and increased revenue to surgery centers across the country. In a time when your costs are rapidly rising, and payers are looking to cut costs, effective revenue cycle management (RCM) becomes especially important.
Medical Billing Challenges for Ambulatory Surgical Centers
Coding and billing are challenging, regardless of the field of medicine, and are a frequent cause of frustration for office staff. The following have been noted as being the source of much of the trouble for ASCs.
- High Rate of Referrals: Before a patient comes to a surgery center, they are typically diagnosed by someone else and referred. Even if the referring physician’s office has confirmed that the surgery center takes the patient’s insurance, they may have different coverage agreements, which can be a source of confusion for patients. The surgery center must make sure everything the patient needs is covered, or that they understand the costs they will have to pay. However, if there is a problem with the way a claim is filed, the patient may receive an unexpected bill and become angry with the surgical center.
- Detailed Medicare modifiers: Coders must be aware of the many circumstances that require different coding, such as whether a hospice patient’s surgery was related to the terminal condition or in the case that a surgery was stopped, whether it was after prep or after the anesthesia was administered. Lack of any of these details in the coding will result in a denied claim.
Payers do not look at suspicious claims and try to ascertain if there is simply something that isn’t clear. If a claim doesn’t meet all the expectations, it will be rejected automatically, and it is up to the provider to figure out what was wrong and correct it to file an appeal. Most claims can be resolved, but it takes a substantial amount of time to sort through the notes and determine what doesn’t match up.
- Variety of patients and payers: Ambulatory surgery centers often specialize and will only need to treat each patient one time, resulting in a constantly changing patient base. Each patient coming through the doors may have a different insurance company or government payer, so all the insurance set-up and processing has to be done for each one.
Medcare MSO Is the Solution to Your Medical Billing Problems
Medical coding and billing are complicated processes and mastering them requires experience on top of training. The codes change annually, and payers change their contracts and coverage’s too, making it impossible for a medical office staff to stay abreast of all the latest developments. Medcare MSO is dedicated only to coding and billing, so it is our business to stay on top of it, and we incorporate all the latest changes right into our proprietary software.
Rejected and denied claims are a significant source of lost revenue for many medical practices and surgical centers, but they don’t have to be. By outsourcing your medical billing to us, your struggles with claims processing will be eliminated and your payments received will greatly increase.
To know more about our ambulatory billing services get a free demo today and let us show you how we can protect your bottom line—and let you get back to focusing on patients.