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ASC billing is the specialized process of managing financial transactions and reimbursements for Ambulatory Surgery Centers (ASCs), including outpatient surgeries and procedures. Billing in these centers involves several key components: accurate coding and documentation of services, submission and management of insurance claims, and handling patient billing and collections. ASC billing also requires adherence to various regulatory and compliance standards to avoid penalties and ensure accurate financial reporting.
However, ASC service providers face billing challenges, such as maintaining coding accuracy, which can lead to claim denials or delays affecting revenue. Additionally, managing insurance claims is complex, involving numerous payer-specific requirements and frequent follow-ups to address denials and rejections. Compliance with evolving regulations adds another difficulty, as a failure to adhere to specified legal standards can lead to costly penalties. Furthermore, ASC providers often struggle with patient billing and collections, especially when dealing with high-deductible plans or uninsured patients, leading to revenue leakage.
Invensis, as a leading ASC billing service provider, streamlines and simplifies the complex billing process in the following ways:
- Collecting patient information, verifying insurance eligibility, and securing preauthorization for procedures to ensure coverage.
- Documenting all services and additional charges, including supplies and medications, during the patient's visit.
- Using appropriate CPT codes, ICD-10 codes, and modifiers to represent the services and diagnoses accurately.
- Entering all charges and coded information into the billing system, ensuring accuracy and completeness.
- Reviewing claims for errors using scrubbing software and addressing issues before submission to reduce claim denials.
- Submitting claims to insurance payers, including considerations for global periods, bundled payments, and confirming receipt.
- Tracking claims and resolving issues, including requests for additional information or documentation.
- Posting payments from payers and patients to accounts, adjusting for ASC payment adjustments as necessary.
- Analyzing and addressing claim denials, including those related to global periods and out-of-network billing, and filing appeals to recover revenue.
- Managing outstanding balances and following up on overdue accounts to improve surgery center payment collections.
- Generating and sending detailed patient bills, managing collections, and offering flexible payment options.
- Reviewing explanation of benefits to understand payment details and resolve discrepancies with patient billing.
- Producing reports, including ASC quality reporting and financial performance metrics, to guide decision-making.
- Ensuring compliance with healthcare regulations and conducting regular ASC billing audits to maintain billing accuracy.
- Reviewing and negotiating payer contracts to secure favorable terms and address issues related to out-of-network billing.
- Continuously assessing and enhancing ASC billing processes based on performance data and feedback to ensure efficiency and accuracy.
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