Surgery Center Medical Billing Services

A surgery center, or ambulatory surgery center (ASC), is a specialized healthcare facility that provides outpatient surgical care and allows patients to undergo procedures and return home on the same day. These centers focus on delivering efficient and cost-effective surgical services without the need for extended hospital stays. Billing for these surgical services involves managing the financial aspects, including accurate coding, submitting claims to insurance providers, and handling patient invoicing. Effective ambulatory surgery billing ensures that the surgery centers receive appropriate reimbursement, maintain compliance with regulatory standards, and manage their revenue cycle effectively.

However, surgery centers frequently encounter several challenges in their billing processes, such as The complexity of coding requirements. Each surgical procedure performed in a surgery center requires precise coding to accurately reflect the procedures, diagnoses, and treatments provided. Inaccuracy in this leads to claim denials, delayed payments, and compliance issues. Additionally, the frequent changes in healthcare regulations and payer policies can make it difficult for surgery centers to stay current. 

As one of the leading ASC medical billing service providers, we help surgery centers streamline the billing process in the following ways:

• Collecting patient demographics, procedure details, charges, service dates, and insurance provider information, including policy numbers and coverage specifics.
• Applying accurate medical coding, such as CPT (Current Procedural Terminology) codes, ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) codes, HCPCS Level II (Healthcare Common Procedure Coding System) codes, revenue codes, anesthesia codes, and appropriate modifiers based on clinical documentation.
• Adhering to healthcare regulations and payer-specific guidelines by selecting the appropriate outpatient surgery billing models (e.g., fee-for-service, bundled payments) and ensuring compliance with federal and state laws.
• Compiling and completing all necessary claim forms, including UB-04 for institutional claims or CMS-1500 for professional claims, and attaching relevant supporting documentation for accurate submission.
• Transmitting claims electronically or manually following specific payer submission protocols and ensuring correct formatting.
• Monitoring claim status using claim tracking systems to confirm receipt and processing by payers and addressing issues or rejections by coordinating with payers to resolve discrepancies or request additional information.
• Analyzing denied claims to identify causes of rejection or underpayment and preparing detailed appeal letters with supporting documentation to challenge denials and secure appropriate reimbursement.
• Maintaining ongoing adherence to evolving healthcare regulations, payer policies, and coding updates, ensuring that all ASC billing and coding systems remain compliant throughout the billing cycle.