Strategies to Improve KPIs in Your ASC Revenue Cycle

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Strategies to Improve KPIs in Your ASC Revenue
Cycle
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Abstract

• Introduction
• ASC Billing and Coding Guidelines an Overview
• Latest Update ASC Payment System
• Strategies to Improve KPIs in Your ASC Billing
• Effectively monitor and measure KPIs to Improve
• About e-Care India

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Introduction

• Ambulatory Surgical Centers (ASC) are outpatient
  surgical centers not requiring patient
  hospitalization or the procedure duration does
  not exceed 24 hours from the time of admission.
• ASCs are standalone centers as CMS regulatory
  does not allow ASC and other medical entities
  such as a medical practice or physician office to
  operate in one common space unless under certain
  conditions.
• As a distinct entity exclusive for outpatient
  surgical services, ASC must sign a written
  agreement with Center for Medicare and Medicaid
  Services (CMS) and be certified and approved by
  CMS as participating providers. 

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ASC Billing and Coding Guidelines an Overview

• ASC services are billed on a combination of
  Hospital and physician billing form CMS 1500 for
  Medicare part B and some third-party carriers,
  while other payors and commercial insurance
  require UB04 for billing ASC claims.
• ASC services are coded using HCPCS Level II codes
  along with ICD -10 CM in certain instances as
  allowed by the payors.

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Latest Update ASC Payment System

• Effective 1st January 2021, CMS has updated
  various changes in the payment system and
  policies for ASCs.
• In the previous update for ASC in 2019 CMS
  included surgery like procedures outside the
  CPT surgical codes that meet required criteria to
  be on the ASC list.
• Now with effect of the current payment changes in
  enrollment, utilization, case-mix changes, ASC
  Medicare payments for 2021 is expected to see an
  increase of 120 million approximately.
• Let us have a broad look into some ASC new and
  revised code changes

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• HCPCS code C9053, which was effective April 1,
  2020, was deleted June 30, 2020 and replaced with
  HCPCS code J0791 (Injection, crizanlizumab-tmca,
  5 mg) effective July 1, 2020.1
• HCPCS code C9056, which was effective April 1,
  2020, was deleted June 30, 2020 and replaced with
  HCPCS code J0223 (Injection, givosiran, 0.5 mg)
  effective July 1, 20201.
• HCPCS code C9057, which was effective April 1,
  2020, was deleted June 30, 2020 and replaced with
  HCPCS code J1201 (Injection, cetirizine
  hydrochloride, 0.5 mg) effective July 1, 2020.1

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• HCPCS code C9058, which was effective April 1,
  2020, was deleted June 30, 2020 and replaced with
  HCPCS code Q5120 (Injection, pegfilgrastim-bmez,
  biosimilar, (Ziextenzo), 0.5 mg) effective July
  1, 20201.
• HCPCS code C9754, which was effective January 1,
  2019, was deleted June 30, 2020 and replaced
  withHCPCS code G2170 effective July 1, 2020.1
• HCPCS code C9755, which was effective January 1,
  2019, was deleted June 30, 2020 and replaced
  withHCPCS code G2171 effective July 1, 2020.1
• HCPCS codes Q4227 through Q4248 The availability
  of an HCPCS code for a particular human cell,
  tissue, or cellular or tissue-based product
  (HCT/P) does not mean that that product is
  appropriately regulated solely under section 361
  of the PHS Act and the FDA regulations in 21 CFR
  Part 1271.1

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Strategies to Improve KPIs in Your ASC Billing

• Billing for ASC requires you to understand the
  ASC setup and its operating conditions under CMS
  regulatory.
• Going through the above overview and latest
  changes will ease understanding billing and
  coding guidelines for ASC Billing.
• Having a streamlined billing process in place
  will optimize the overall billing experience and
  result in improved revenue cycle management for
  Ambulatory Surgery Billing.

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Effectively Monitor and Measure KPIs to Improve

• By closely monitoring key performance indicators
  (KPI) and tracking them
• will help identify lags, default in the process
  and streamline them. Have a
• checklist of KPIs as below to be tracked and
  monitored regularly for
• consistent and improvised results.
• Closely monitor each claim and track its average
  bill days to ensure each and every claim is
  billed within the timely filing limit (TFL) and
  paid appropriately. Unwanted delays in billing
  will lead to claim denial, lost or reduced pay.

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• Have a track on the payment days of each
  insurance payer. Each insurance will have
  different payment days from the claim submission
  date, tracking it will help you understand the
  payment process and schedule follow-up if
  required.
• Tracking Old AR aging more than 90 days will help
  decrease your revenue loss and maintain a healthy
  billing process. It is ideal to make sure that
  your old AR does not cross more than 10-15.
  Anything exceeding this can be a sign that your
  billing is overlooked and needs immediate
  attention and corrective measures for effective
  and productive results.
• Keeping a track of the denial reason and
  educating your billing and coding staff on
  repeated errors to reduce denial percentage.
• Outsourcing your ASC billing to an offshore-based
  Medical Billing company can help enhance your
  billing process and your monthly collections.

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About e-Care India

• e-Care is one of the top medical billing
  companies in India with more than 20 years of
  experience in the industry, e-Care provides end
  to end billing services to more than 80 Clients
  across US. e-Care is a multispecialty medical
  billing company having expertise across more than
  28 specialties. Our team has a clear
  understanding of the payer guidelines for ASC
  billing in various states. To know more about our
  ASC billing visit Ambulatory Surgical  Center
  (ASC) Billing Services e-care India
• Reference
• 1https//www.hfma.org/content/dam/hfma/Documents
  /industry-initiatives/fact-sheets/cy2021-opps-asc-
  final-rule-summary.pdf
• Source https//www.ecareindia.com/blog/strategie
  s-to-improve-kpis-in-your-asc-revenue-cycle/

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THANKS!

• Any questions?You can find us at
• 1 813 666 0028
• info_at_ecareindia.com
• www.ecareindia.com

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