ASCs: Pay Increase and Overbilling

Why This Topic Matters

ASC reimbursement and site-of-service billing rules can affect both revenue and compliance risk. The article highlights a situation in which Medicare payment handling and claim submission practices may create exposure to overpayment recovery or audit scrutiny.

Article Sections

1. ASC payment update

   Covers a Medicare payment adjustment for ambulatory surgical centers and the general context for annual ASC rate changes. It also notes the relationship between facility payments and Medicare’s approved ASC procedure list.

2. Overbilling concern for SI joint injections in an ASC

   Discusses a billing and compliance issue involving sacroiliac joint injections performed in an ASC. The section addresses the overlapping use of a HCPCS code and a CPT code in the ASC setting and the resulting risk of duplicate payment or overpayment review.

3. Government audit and recovery actions

   Summarizes audit activity and carrier recovery concerns related to ambulatory surgical procedures billed with incorrect site-of-service information. It highlights the compliance implications of billing errors identified by federal oversight agencies.