Ambulatory Surgery Centers (ASCs) have emerged as a crucial player in the healthcare industry as they offer a convenient and cost-effective alternative to hospital-based procedures. As the demand for ASC services continues to increase, it is imperative that these centers adopt a comprehensive and efficient billing process to ensure accurate and timely reimbursement.
The U.S. ambulatory surgical centers market is predicted to expand at a CAGR of 6.5% within the forecasted period, with an estimated market size of USD 58.85 billion by 2028, as per market research. This growth projection comes after the ASC market value reached USD 30 billion in 2020. The growing preference for ambulatory surgical centers in the U.S. is expected to be a significant driving factor for market growth in the future.
However, RemitDATA® reports that ASCs are facing financial pressure due to high denial rates alone, with New York having the highest denial rates (37%) for such surgery centers, followed by Georgia (27%), and Kentucky (22%). Therefore, it is crucial for ASCs to optimize their billing process to avoid financial losses.
In this blog, we will discuss the importance of ASC billing, its definition, and some best practices for optimizing the billing process.
What is ASC Billing?
Ambulatory Surgery Center (ASC) billing denotes the procedure of presenting claims to insurance firms and other payers for the medical procedures conducted in an ASC. This includes the process of confirming the patient’s insurance coverage and eligibility, submitting claims, tracking outstanding claims, and appealing denied claims. The process of ASC billing is intricate and subject to constant change, requiring extensive knowledge to ensure that the reimbursement is correctly processed. In the face of rising operational expenses, declining revenues, and increasing patient responsibility, surgery centers cannot afford to overlook any remuneration, making efficient and precise billing practices a necessity.
Why is ASC Billing Important?
The financial stability of ASCs is dependent on accurate billing and appropriate reimbursement. ASCs that lack a dependable billing process run the risk of financial loss resulting from claim denials or payment delays. Such circumstances may undermine the ASC’s capacity to offer top-notch patient care and invest in advanced medical technology and equipment. Furthermore, non-adherence to billing regulations may lead to penalties, fines, and possible legal action. It is important that organizations invest in the right software and professionals or even outsource it to experts in the field who can ensure that the process is up-to-date and help bring in more revenue.
Best Practices for ASC Billing
- Accurate coding is a crucial element of the billing process, determining the precision of the claim and the amount of reimbursement. Hence, it is imperative that your ASC employs trained RCM professionals who are conversant with current coding guidelines and can correctly assign the appropriate codes to each procedure.
- Verification of insurance coverage is a vital step before proceeding with any procedures. It aids in preventing surprises for the patient and ensures claims are presented to the correct payer. Our software expEDIum can be of great assistance in streamlining the process as it supports both real-time and batch verifications.
- Timely claim submission is pivotal in reducing the possibility of denied claims or payment delays. Your billing team must have the requisite resources and tools to submit claims promptly.
- Effective follow-up on unpaid claims is necessary to guarantee prompt reimbursement. Establishing a method for tracking unpaid claims and formulating a plan for timely follow-up is paramount.
- Staying updated on regulations is indispensable, considering the frequent alterations in healthcare regulations that may affect your ASC’s billing process. Utilizing medical billing software that is regularly updated with the latest regulations ensures compliance and averts potential penalties or legal action.
Ambulatory Surgical Centers (ASCs) hold a crucial position in providing same-day surgical care. However, the shifting landscape of the U.S. healthcare industry has brought forth various challenges for the ASCs. These centers not only face the hurdle of fluctuating reimbursement rates but also encounter the predicament of physicians gravitating towards hospital employment and the pressure to provide cost-effective care.
ASC billing is an intricate and dynamic process, necessitating extensive knowledge to ensure proper reimbursement. The increasing operational costs, declining revenues, and rising patient responsibility demand that ASCs employ efficient and accurate billing procedures, without which they cannot afford to forgo any revenue.
If you require any assistance with medical billing-related queries, please contact one of our representatives here, and we would be delighted to assist.