Electronic Health Reporter

By Isaac Smith, healthcare content strategist, Medcare MSO.

If you are involved in the healthcare industry, you must be familiar with the terms “ASC Coding and Billing” and “Physician Medical Billing.” These two concepts are important to understand if you are a healthcare provider or if you run a healthcare facility. In this article, we will discuss the differences between ASC Coding and Billing and Physician Medical Billing.

Medical billing and coding are critical components of the healthcare industry. They are the processes that ensure that healthcare providers get paid for their services. Medical billing and coding can be complex and challenging, especially if you are not familiar with the terminologies involved. In this article, we will simplify the concepts of ASC Coding and Billing and Physician Medical Billing.

Starting January 1, 2008, the CMS publishes annual updates to the list of procedures an ASC can be paid for. To establish payment indicators and rates for newly created Level II HCPCS and Category III CPT Codes, CMS updates the lists of covered surgical procedures and ancillary services quarterly. ASC billing and coding are explained below.

On the CMS website, you can find the complete lists of ASC-covered surgical procedures and ancillary services, the applicable payment indicators, payment rates before regional wage adjustments, wage-adjusted payment rates, and wage indices.

ASC certification and a CMS agreement are required for this provision. ASCs must accept Medicare’s full payment for ASC services. Physicians and anesthesiologists can bill and be paid for professional services.

Lab services and non-implantable DME can be billed using the correct certified provider/supplier UPIN/NPI. The basics of ambulatory surgery center billing are simple, but physician and facility requirements differ. Physician and facility billing are different from ASC billing. ASC billing and coding don’t focus on a medical specialty like physician medical billing, which must follow a few highly specialized guidelines to get reimbursed.

ASC Coding and Billing

ASC stands for Ambulatory Surgical Center. An ASC is a healthcare facility where surgeries that do not require an overnight stay are performed. ASCs are becoming increasingly popular because they are less expensive and more convenient than traditional hospital settings. ASCs have their own set of codes and regulations that are different from those of physician medical billing.

ASCs are reimbursed for their services based on a fee schedule set by Medicare. The fee schedule is based on the geographic location of the ASC, and the complexity of the surgical procedure. The fee schedule is also updated annually to reflect changes in the costs of providing healthcare services.

ASCs have their own set of codes that are used to bill for their services. These codes are different from those used in physician medical billing. ASC codes are more specific and detailed, as they are designed to describe the unique services provided in the ASC setting.

ASC Coding: ASC coding is more complicated than physician billing. ASCs must code multiple procedures and services, unlike physicians. For proper reimbursement, ASC coding must follow specific guidelines and codes.

ASC Billing: CPT is the main ASC coding system. This coding system lets doctors bill insurers for services. ASCs use CPT and ICD-10 codes to identify medical diagnoses and conditions.

ASC billing differs from physician billing. Facility fees cover the surgery center, staff, and equipment at ASCs. ASCs may also charge for the surgeon’s fee and other surgery services. ASCs must follow billing guidelines to get reimbursed. Code and document correctly, verify insurance coverage, and bill correctly.

Physician Medical Billing

Physician medical billing refers to the billing and coding processes used by physicians to bill for their services. Physicians can bill for their services in a variety of settings, including hospitals, clinics, and private practices.

The billing and coding processes used in physician medical billing are similar to those used in ASC coding and billing, but there are some important differences. For example, physician medical billing codes are more general than ASC codes. Physician medical billing codes are designed to describe the services provided by physicians in a variety of settings, whereas ASC codes are designed to describe the unique services provided in the ASC setting.

Differences Between ASC Coding and Billing and Physician Medical Billing

ASC billing and coding differ from physician billing in several ways. ASC billing often involves multiple services and procedures, while physician medical billing usually involves one.

ASCs charge facility fees, unlike physicians. Finally, ASC coding and billing must follow strict guidelines and codes to ensure proper reimbursement, while physician billing may not.

Now that we have discussed the basics of ASC coding and billing and physician medical billing, let’s compare the two.

The first major difference between ASC coding and billing and physician medical billing is the setting in which the services are provided. ASCs are healthcare facilities that specialize in surgeries that do not require an overnight stay. Physician medical billing can be used to bill for services provided in a variety of settings, including hospitals, clinics, and private practices.

The second major difference between ASC coding and billing and physician medical billing is the codes used to bill for services. ASC codes are more specific and detailed than physician medical billing codes. This is because ASCs provide unique services that are not provided in other healthcare settings.

Conclusion

In conclusion, ASC coding and billing and physician medical billing are two important concepts in the healthcare industry. While both processes involve billing and coding, they are different in many ways. ASC coding and billing is used to bill for services provided in ASCs, while physician medical billing can be used to bill for services provided in a variety of settings. ASC codes are more specific and detailed than physician medical billing codes. It is important to understand the differences between these two concepts if you are involved in the healthcare industry.