Medicare Compliance & Reimbursement

Keep this handy list as a reminder.

Billing for ASC services can be quite different from billing for inpatient facilities or physician offices. Keep these points in mind to help stay on track when billing ASC services:

• Read the entire OP report before coding the claim.
• Per Medicare, only procedures documented in the body of the OP report are billable.
• Be wary of physicians’ use of “canned” OP reports.
• Be sure each service billed is properly documented prior to billing it.
• Review EOBs for denial reasons regularly — look for trends.
• Sequence CPT® codes for billing from highest to lowest by the fee you will be paid by the payer — not your facility’s fee.
• Check Medicare Bulletins monthly for changes to policies for procedures performed in your ASC facility.
• Be aware of any Medicare LCD (local coverage determination) medical policies for procedures performed in your ASC — be sure to follow diagnosis lists and list a covered diagnosis first on claim.
• Check with payers for policies on billing for implants.