decisionhealth Newsletters, decisionhealth - 2010 Issue 11 (November)
Getting paid: Get ready to appeal more ASC denials
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Article Overview
This article reviews CMS clarification related to claims for services performed in an ambulatory surgery center and why those claims may be denied at the global-service level. It is intended for physician practices, coding and billing staff, and reimbursement professionals who need to understand the general denial context, the role of Medicare claims processing guidance, and the types of remittance or Medicare summary notices that may appear on denied claims.
Why This Topic Matters
ASC-related denials can affect whether a practice is paid for work performed in a facility setting, so understanding the general claims-processing context helps billing teams recognize and respond to denials appropriately.
What You Will Learn
- How CMS guidance relates to denied ASC claims
- Why ASC place-of-service claims may be processed differently from other claims
- What kinds of denial and remittance indicators may appear on these claims
- How the article frames the reimbursement issues at a high level
Who Should Read This
- Physician practices
- Medical coders
- Medical billers
- Revenue cycle staff
- Reimbursement specialists
Codes Discussed
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