Chat with us, powered by LiveChat
home
Plutus Health Specialties

ASC Billing & Coding Services

Plutus Health revenue cycle management solutions for Free Standing ASCs provide excellent coding and billing services from our experience of many years in ASC billing which are compliant services with all the federal and state regulations.

Get Started

Please enter your details below and one of our team members will contact you shortly.


Website


Website
*We Value Your Privacy.
*We Value Your Privacy.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
This is some text inside of a div block.

Ambulatory surgery centers (ASCs) need to be financially sound to provide affordable, high-quality same-day surgeries and pain management to their patients. Proper ASC billing and coding systems can ensure that your outpatient surgery center is able to deliver the much-needed outpatient services and stays viable.

Outsource your ASC billing functions to Plutus Health Inc. We can address the challenges that may compromise your ASC’s revenue performance, including coding mistakes and denials.

Plutus Health revenue cycle management solutions for Free Standing ASCs provide excellent coding and billing services from our experience of many years in ASC billing which are compliant services with all the federal and state regulations. We understand all the nuances of ASC billing and maximize the reimbursement of the physicians using efficient billing methodologies.

Reimbursement for surgical services has become  difficult as the ASC space evolves. ASCs are now dealing with very complex insurance carrier policies, multiple guidelines that govern contracted and out of network payer types. This requires deep expertise of payer policies and trends.

There are many important aspects of filing a claim for services rendered through an ASC. Medicare often has different guidelines than some commercial payers, and the payers themselves often differ regarding medical necessity, approved procedures, or other filing requirements.

A leading ASC medical billing service provider, Plutus Health Inc. can:
  • Stay on top of code updates for error-free claim submissions
  • Manage payer contracts, identify issues regarding local coverage determinations, rules regarding care plans, bundled payments, etc., and resolve them quickly
  • Review denials and file appeals
  • Provide analytics and business intelligence reports

Our expert-level ASC billing services will improve your collections, increase your overall financial viability, and ultimately allow you to provide the best care for your patients.

ASC Coding 

One of the most common coding mistakes is coding based on a procedure’s headings instead of the actual surgical report. This is bound to result in a denial once it reaches the payer. Other common errors include misreporting open and arthroscopic techniques as one procedure.

Since an ASC uses a combination of physician and hospital or clinical billing, employing the CPT and HCPCS level codes, some insurance carriers permit an ASC to bill using ICD-10 procedure codes. Some “packaged” services such as medical or surgical supplies not on a “pass-through” status, surgical dressings, splints, casts and related items, supervision of an anesthesiologist by the operating surgeon, and so on.

Managed care contract review

How long you have to submit a claim, how long you have to review an adjudicated claim, what the payment methodology is, why a carrier would reduce multiple procedures and how to appeal a claim that hasn’t been paid correctly. Your ASC should use your managed care contract to bill out, post payments and follow up, and you need it at every point of the revenue cycle.

Appeals

Plutus Health will deliver sophisticated ASC  appeals for surgery denials that include but not limited to payer exclusions, prior authorization, timely filing, usual and customary allowable etc. Plutus Health’s expertise in changing payer guidelines, denial and payment trends, as well as client-specific issues to ensure surgery reimbursement for your Ambulatory Surgery Center is best in class. Plutus Health will aggressively pursue appeal options as well as negotiated settlements for in and out-of-network claims. Plutus Health’s team of reimbursement strategists brings broad experience from both payer and provider sides.  

Outsourcing to Plutus Health Inc. gives you instant access to a skilled revenue cycle team that uses the latest technologies to deliver significant bottom-line improvements. We also provide key analytics, recommendations, and actionable insights to help you maximize profitability, physician disbursements, and overall efficiency.

Take control of your ASC’s financial health

Effective revenue cycle management (RCM) is another pivotal factor in safeguarding your ASC’s finances. Request an RCM assessment to identify current weaknesses in your processes and workflows.

Find out how to achieve maximum reimbursement on your ASC claims.

Contact Us Now to Fix Your A/R and Claim Denials

Stay abreast of the latest ASC trends and policy updates with our resources

Blogs:
Case Studies:

Coding for ASCs is a specialty into itself. It is a facility service, but Medicare requires ASC’s to send their bills to the professional fee (Part B) payers but using the facility fee (Part A) claim form. There are a different set of regulations and bundling edits to use for ASCs. A simple modifier used incorrectly can be denied for an otherwise clean claim for thousands of dollars. You may lose your money if your codes are not in right order.  Insurance Carriers who do not follow standardized coding practices because of HIPAA exemption. Worker’s compensation carriers, small carriers and other carriers that are HIPAA-exempt can come up with home-grown codes, and you are not going to get paid if you use standardized codes. To avoid having your claims rejected, make sure you know whether your carrier is exempt.

Plutus Health has built deep expertise of revenue cycle processes to ensure optimal reimbursement for all ASC services. From accurate demographic capture, coding, and pre-billing audits and scrubbing, to deep EOB analysis, we will navigate on your behalf ASC coding & billing as well as denial  complexities.

Since ASC Facility & Professional Services insurance billing & Out of Network collections are specialized activities most billing services have little or no knowledge of the challenges in this area.  One of the issues is  ASC billing uses a combination of hospital and physician billing. However, ASCs use CPT and HCPCS Level II codes to bill most of their services, some payers will allow an ASC to bill ICD-9-CM procedure codes like hospital. Some payers even base implant reimbursement on revenue code classification. ASC billing challenges are many and complicated.

Get Started

Please enter your details below and one of our team members will contact you shortly.


Website


Website
*We Value Your Privacy.
*We Value Your Privacy.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Discover

Contact Us

FREE HEALTH ANALYSIS

Send us an inquiry and I'll get back to you as soon as possible.

Name:
Phone:
Email:
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.