Billing Best Practices: Useable Tips

Ambulatory surgery centers (ASCs) across the country are still waiting to see how the new ASC rules [Centers for Medicare & Medicaid Services (CMS)] are sifting out.

On Jan. 1, approximately 450 non-office-based and 360 office-based procedures were added to the list of acceptable ASC services, so that more than 3,000 procedures appeared on the CMS final list. Centers must pay special attention to the procedures that were not billable prior to 2008 since some may be able to expand their revenue and keep operating rooms (ORs) busier than in past years. There are opportunities to optimize reimbursement for single-specialty centers, as well as multi-specialty centers, with proper documentation and coding, but there are opportunities to be hurt by the new rules too.

Coding and billing personnel first need to know what is included in each payment:

>>administrative, housekeeping items and services, recordkeeping

>>nursing services, services of technical personnel

>>facility use such as pre-operative areas, OR and recovery room areas

>>diagnostic or therapeutic items and services

>>materials and supplies used for anesthesia

>>blood, blood plasma, platelets, etc., except for those applied to the blood deductible

>>supplies not on “pass through status”

>>intraocular lenses (except new technology lens)

Necessary tools of the trade and resources include current yearbooks or software for CPT, ICD-9-CM, and HCPCS Level II codes; references for NCCI edits; and information coming from Part B Medicare sources.

With the four-year phase-in period, some specialties will notice a drop in reimbursement while others will see an increase with the commonly performed procedures. It is important to understand that even though there will be no annual inflation update for 2009, it does not mean that rates will not change. The annual changes in the procedures’ relative values and the four-year phase-in will cause rates to change.