I am the coder/biller for a mid size podiatry practice. In January we will be adding a surgery center. I need all the help I can get! I don't even know where to start, I have never billed for a surgery practice before and we are starting from scratch!
Thanks so much!
Jessi
Well, you have a lot of work to do!! Surgery center billing is not that hard - but- you have to have your billing programs in place.
1- surgery center claims are billed on a UB-04 and use revenue codes.
2- surgery center claims are paid by grouper (groups 0-10) with commercial carriers and each cpt code falls into a specific grouper as specified by each commercial carrier. This payment is a flat rate and includes all supplies, equip, staff etc for the case
3- you will want to make sure your contract has lingo that states implants are paid separately (usually cost plus 10% and that they do not put minimum dollar amount on the implant)
4- you will want to make sure your contract does not limit how many line items are paid or puts a cap on a payment per case. for example- a lot of insurances will only allow 3 line items to be billed and paid per date of service (no matter how many lines you bill) or will boldly state in the contract that the maximum payment for any case is 1500.00
5- you will want to make sure that unlisted codes pay at a default grouper in your contract
6- Medicare has an ASC list of approved procedures - if the cpt code you are doing is not on that list- Medicare will not pay you at all!!!!
If you need more help feel free to email me
capricew73@gmail.com
Good luck!!!
Caprice Walder, CPC
3- you will want to make sure that