decisionhealth Newsletters, Answer Books - 2009 Issue 1 (January)
Ambulatory Surgical Centers / Medicare denials
Subscribe or sign in to view the full article.
Article Overview
This article covers Medicare policy for ambulatory surgical center claims, including how ASC eligibility affects payment, denials, and facility-fee billing. It is intended for coders, billers, ASCs, and physician practices that need to understand the difference between covered and non-covered ASC procedures under Medicare and the related claim outcomes referenced by CMS guidance.
Why This Topic Matters
ASC claims can be denied or paid differently depending on whether the procedure is on the Medicare-approved ASC list and whether the billing entity is the ASC or the physician. Understanding the policy helps prevent improper patient billing and supports correct claim submission.
What You Will Learn
- How Medicare distinguishes between ASC facility claims and physician claims for procedures performed in an ASC
- Why certain ASC claims are denied or treated differently when a procedure is not on the approved list
- How Medicare policy affects facility-fee billing and patient billing in the ASC setting
- Where CMS publishes the ASC procedure list and related payment information
Who Should Read This
- Medical coders
- Medical billers
- Ambulatory surgical center staff
- Physician practice administrators
- Revenue cycle professionals
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com