3 Common Overlooked ASC Billing Opportunities
ASCs can easily leave significant money they are rightfully owed on the table because of missed billing opportunities. Below are three frequently missed opportunities that share another common trait: They are billing opportunities separate from billing for procedure codes.
1. Nerve blocks
We have found that many ASCs with in-house revenue cycle management miss the opportunity to get paid for nerve blocks because of a belief that only the anesthesia provider can bill for the block. ASCs can get paid for these injections as well when performed for the purpose of controlling post operative pain.
At Surgical Notes, we reconcile all post-op pain blocks to ensure there is no missed revenue, often collecting several hundred thousand dollars and even a million dollars or more annually for clients.
2. Surgical implants
It's easy to get tripped up by surgical implants. Physicians don't always dictate the full details of the implant(s) used, which are essential to proper coding and billing. Even when physicians fully complete their dictation, there are often coding misses that lead to lost revenue. Implant logs must be carefully audited to ensure the details dictated by providers match those for the implants documented in logs.
Another potential problem is not staying on top of the current pass-through devices. Pass-through status is determined for newly FDA-approved drug and devices. If the pass-through HCPCS is not billed correctly, it will result in a denial. CMS updates its pass-through devices on a quarterly basis. A pass-through is typically approved for a minimum of 2 years.
Other problems that lead to missed implant billing opportunities include not billing the required HCPCS code(s) per payer requirements (e.g., L-code versus C-code).
Understanding unit maximums is also important. Even if billing is performed correctly, an ASC should understand there may be maximum allowances for implants. A center could lose significant revenue if, for example, an implant costs $5,000 for five units but the payer's clinical policy stipulates it will only allow two units to be paid $2,000 maximum.
3. Biologics
The final common missed billable opportunity we're highlighting concerns is billable biologics. This opportunity, which has increased in frequency over the past several years, can be missed if a provider does not dictate the use of the biologic (e.g., Exparel, ZynRelef, Botox, Omidria) during the procedure. Failure to bill with the required national drug code number and billing incorrect units are also problematic.