Focused RCM Solutions for Ambulatory Surgical Centers
An Ambulatory Surgical Center (ASC) is a healthcare facility that provides same-day surgical care, including diagnostic and preventive procedures, without the need for an overnight hospital stay. Ambulatory Surgical Centers are gaining popularity in the outpatient market due to their affordability as they seem to be the future for reducing costs. More than half of outpatient surgical procedures are carried out at ASCs today and according to recent reports, this trend is set to see an uptick of nearly 15% by 2028.
Our team of CASCC™ certified professionals are experienced with the nuances of ASC billing, including the unique requirements of various payers and the importance of timely submission and follow-up of claims. We utilize the latest technology and software to ensure accurate and efficient processing of claims, minimizing the chances of errors and denials. Our comprehensive revenue cycle services include:
- Patient Registration and Demographic Entry
- Pre-Authorization and Eligibility Verification
- Procedure Documentation
- Coding and Quality Audits
- Claim Submission
- Payment and Statements
- Patient Billing
- Accounts Receivable Management
- Old A/R Clean-up and Recovery
- Reports
-
Certified Resources
Our specialists are AAPC™ & AHIMA™ certified.
-
HIPAA Compliant
Ensuring absolute privacy, security and integrity at all times.
Navigate the Billing Landscape with Confidence
The ASC revenue cycle process requires careful attention to detail and a thorough understanding of the ASC payment system and regulatory requirements. Our team of seasoned professionals help streamline your revenue cycle processes, and ensure timely and accurate payment for the services rendered. Below are examples of prevalent challenges we've successfully guided ASCs in sidestepping:
- Patient Registration Hurdles
- Pre-Authorization Concerns
- Coding Challenges
- Denial Management
- Mitigating Underpayments
- Addressing Coordination of Benefits (COB)
- Ensuring Accurate Documentation
- Navigating Compliance Issues
- Managing Out-of-Network Situations
- Staffing Solutions
Get a Tailored Quote Now!
Ready to explore a tailored pricing plan that fits your unique needs? Simply fill out a brief form and let us connect with you. Our experts will design a personalized pricing strategy that aligns perfectly with your Ambulatory Surgical Center's unique requirements.
Free Consultation
Where Nuance Meets Expertise
The billing process for Ambulatory Surgical Centers (ASCs) can be complex, as there are several factors to be aware of. Here are some key points to keep in mind:
-
They Bill Differently
ASCs are paid using a different billing system than hospitals, known as the ASC payment system. This system pays ASCs a fixed amount based on the procedure performed, rather than billing for individual services.
-
Payments are Different
The ASC payment system is based on the procedures and not the time taken to perform it. This means that if a procedure takes longer than expected, the ASC will not receive additional payment for the extra time spent.
-
Bundled Payments
The ASC payment system bundles payments for all services related to a procedure, including facility fee, surgeon's fee, and any anesthesia services. This means that ASCs must negotiate rates with multiple payers to ensure that they receive adequate reimbursement for all services provided.
-
Coding and Documentation
Accurate coding and documentation are critical for ASC billing. ASCs must use the correct codes and modifiers to describe the procedure performed, and documentation must be thorough and comprehensive to support the services billed.
-
Reimbursement Rates Vary
Reimbursement rates for ASCs can vary depending on the procedure performed, its location, and the payer involved. ASCs must negotiate rates with payers to ensure they receive fair reimbursement for their services rendered.
-
Medicare Rules
ASCs that provide services to Medicare beneficiaries must follow specific billing and coding regulations. These rules are complex and require careful attention to detail to ensure compliance.
Overall, ASC billing requires careful attention to detail and a thorough understanding of the ASC payment system and Medicare rules. Enlist our expertise to help you navigate the regulatory landscape, negotiate fair reimbursement rates with payers, streamline and organize your revenue cycle and ensure accurate coding and documentation to receive appropriate payments for their services.
Why Leading ASCs Partner with Bristol Healthcare
At Bristol Healthcare, we boast a dedicated Cardiology department, staffed with AAPC-certified coders working exclusively towards serving cardiology practices. They possess extensive experience and proven expertise in optimizing and streamlining workflows for an enhanced revenue cycle experience.
- +1 million charts coded annually.
- 98% Claim first-pass rate.
- Up to 40% reduced expenses.
- Best-in-class turnaround time.
- AAPC™ & AHIMA™ certified resources.
- ICD-11, ICD-10, CPT-4, and HCPCS coding proficiency.
- Thorough coding audits and regularized QA checks.
- Dedicated account manager.
- Affordable & flexible pricing plans.
- End-to-end encryption of patient data.
- Strict HIPAA compliance.
- 24x7 Support.
Maximize Profits, Minimize Hassles - Get Started!
Discover how our specialized ASC billing expertise can optimize your revenue cycle. Schedule a consultation with us today, and let's tailor a solution that streamlines your financial processes, ensuring you get the maximum returns for your Ambulatory Surgical Center.
Free ConsultationCommonly Used CPT, ICD Codes and Modifiers
The medical codes used in Ambulatory Surgical Centers (ASCs) are standardized codes that help describe the medical services provided during a procedure. Here are some of the most common medical codes used in an ASC:
They are used to describe medical procedures and services performed during a procedure. ASCs use CPT codes to bill for the facility fee and the surgeon's fee.
- 45378 - Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure).
- 29881 - Arthroscopy, knee, surgical; with meniscectomy (medial or lateral, including any meniscal shaving).
- 66984 - Cataract extraction with intraocular lens implantation, 1 stage, manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification).
- 43239 - Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple.
- 31624 - Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of foreign body.
- 11400 - Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 0.5 cm or less.
These codes are used to describe the diagnosis of the patient's medical condition. These codes help determine medical necessity and support the need for the procedure performed.
- K43.9 - Ventral hernia without obstruction or gangrene.
- M23.1 - Internal derangement of knee, unspecified.
- K35.3 - Acute appendicitis with generalized peritonitis.
- H40.9 - Glaucoma, unspecified.
- M25.511 - Pain in right shoulder.
- Z12.11 - Encounter for screening for malignant neoplasm of colon.
They are used to describe medical equipment, supplies, and services used during the procedure. These codes help identify the specific items used during the procedure for billing purposes.
- G0105 - Colorectal cancer screening; colonoscopy on individual at high risk.
- G0121 - Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk.
- G0439 - Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit.
- G0500 - Initial preventive physical examination (IPPE).
- G0431 - Drug screen, qualitative; multiple drug classes by high complexity test method.
Revenue codes are used to identify the specific departments and services provided by the ASC, such as operating room services, recovery room services, or laboratory services.
- 360 - Operating room services.
- 450 - Emergency room.
- 636 - Drugs requiring detailed coding.
- 761 - Direct care of inpatient.
- 490 - Clinic, general classification.
Modifiers are used to provide additional information about the services provided during the procedure. They can help indicate if a service was performed on multiple sites, if the procedure was performed on a laterality (e.g., left or right side), or if multiple procedures were performed during the same session.
- 50 - Bilateral procedure.
- 51 - Multiple procedures.
- 59 - Distinct procedural service.
- 76 - Repeat procedure or service by the same physician or other qualified healthcare professionals.
- 78 - Unplanned return to operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period.
Please note that these are just a few examples, and there are many other codes and modifiers used in ASCs. By using these codes correctly, ASCs can ensure they are paid appropriately for the services they provide.
What Our Clients Say
Together with our clients, BHS experts partner to achieve desired outcomes
and push the boundaries of what's possible.
“Jay – Great. I really appreciate your in-depth analysis on our outstanding. Your AR recovery process has been excellent.”
“We greatly appreciate the conscientious nature of your team. Their concern for quality is clear in the work that they perform.”
“Your attention to detail is excellent. Thanks for catching my staff’s error. I just love talking to Ray about process improvements.”
“Jay! Thanks to you and your team for formulating a winning team! I am proud to be aligned with you guys!”
“Our partnership with Bristol proved to be a game-changer. Their expertise in revenue cycle management and their commitment to delivering excellent service has truly transformed our practice's financial outlook.”
“If it wasn’t for your verification team, I would’ve never known I needed authorization for this surgical procedure. They have consistently sent verified reports on time, every day.”
“I highly recommend Bristol to any healthcare provider seeking a reliable and efficient medical billing partner. Their commitment to excellence, attention to detail, and dedication to maximizing revenue has been instrumental in helping our practice thrive financially.”
“Do you guys ever sleep? Thank you for answering all my questions immediately. I can’t imagine what I will do without your team.”
“I thank your coders for clearing our four months backlog within two weeks. I appreciate all your recommendations, it surely helps to improve our documentation.”
“Partnering with Bristol has been one of the best decisions I've made for my clinic, and I am grateful for their invaluable support."
“You have consistently provided accurate billing entries for us. I thank the entire team for a job well done."
“Your follow-up methodology seems to be working. Our collections have been increasing month on month. Great job! Stay on it.”
“I wanted to pass on our appreciation for the work the Bristol team is doing on the new BristolByte™ Quick Save feature. I am quite impressed by the speed with which the team is making design changes and implementing a process that will surely save us time. We appreciate it!”
“Their team took the time to understand our practice’s unique needs and workflows to implement a personalized billing process that ensured improved reimbursement rates. We’ve now eliminated duplicate data entry, minimized errors, and saved our staff valuable time.“
“With their expertise in managing our billing processes, we have been able to focus on what truly matters – delivering outstanding orthopedic care to our patients.”
