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A Thing or Two About Ambulatory Surgical Billing Services

Surgical billing services are different from among the different kinds of medical billing for specialties. It is vital to the revenue cycle management process to get it right before getting into the billing part. Ambulatory surgical billing holds course for creating claims for surgical interventions in an outpatient setup. Procedures related to pain management and colonoscopies are what may come by rather frequently.

Factually speaking, the procedures doctors deliver in ASCs are more complex compared to what they may do in their offices. Clinical visits do not require prior hospitalizations of patients. For effective billing solutions, the procedures qualify under specific circumstances. Additionally, providers are to follow strict CMS recommendations.

Your medical billing company must know ambulatory billing because it is unlike billing for physicians. If they lack the knowledge, you might be leaving money on the table as we speak.

While Medicare has its requirements for medical billing for ASCs, other insurance companies have their own. They may differ from payer to payer, depending on medical necessity, allowed procedures, and other filing agreements.

Medical Billing for ASCs

On the whole, medical billing for ASCs takes on a different approach. That is because ASCs manifest a mixture of hospital and practice-related procedures. The resulting situation confuses the insurance companies alongside the billing companies. For better outcomes, the provider billing services should know their jobs better.

Medicare follows a different set of protocols for ambulatory billing; moreover, it does not cover ASC’s claims under Medicare Part B claims. It is essential for ASCs to bill and code according to a predefined set of requirements.

Is your medical billing outsourcing service aware of these requirements?

If they are, consider yourself on the way to accurate reimbursements, otherwise, it may get awkward.

Sometimes insurance companies are not on the same page with CMS guidelines for ASC billing. It may become uneasy for the medical billing and coding staff to file claims.

To get reimbursed effectively, you ought to code for correct procedures, submit at the right time, and follow the contracts.

About ASCs

Ambulatory surgical centers (ASCs) are places where patients undergo surgical treatment.

MIPS in value-based care aims at the reduction of healthcare expenses. In brief, the end-goal of an ASC is to function optimally, with fewer hospitalizations and surgical interventions.

How Are ASCs Billed?

As discussed above, ASCs are billed using CPT coding terminology. Only a few payers allow billing companies to use the ICD system similar to what they use for hospitals.

While submitting the charges to point-out services rendered by an ASC, Medicare requires the use of modifiers. So, we must deploy modifiers before submitting the claims!

Moreover, other insurance companies may prefer modifiers as well. It helps them distinguish between a collective bill and an individual bill. Before jumping to conclusions, please first check with insurance companies about their ambulatory medical billing prerequisites.

CMS Regulations and Criteria

You must know beforehand what services to bill for in an ASC setup. Not all the services that are allowed for a hospital are a go for an ASC. Henceforth, the type of services to bill for is our first clue in solving the ASC puzzle.

The criteria for a procedure:

• First, it should not be life-threatening or an emergency

• Second, your office – doctor’s office – is not enough for it.

• Third, it is both urgent and elective.

Common Errors in Medical Billing for ASCs

There is a certain amount of wait time before surgical billing. It is not abrupt because as we have to wait for the doctor’s report. Immediate billing does not help because there are yearly manifestations for it.

Further errors occur in the form of misinterpretation of open and arthroscopic activities. It occurs when the treatment starts arthroscopically but later takes the open route.

Most medical billing and coding services bill erroneously for both when they need to code only for one.


In this article, we hope to dispense enough information for you to understand ambulatory surgical billing. If you are having trouble with your surgical billing, please refer to P3 Healthcare Solutions since we are a specialty medical billing company.

About P3care Solutions

P3 offers Health IT, Medical Billing, and MIPS Consulting Services across the 🇺🇸. For accurate reimbursements💲, call 📞(909) 245-8350 or email ⌨

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