Effective ASC billing requires up-to-date coding, staff training, and audits that help prevent errors, delays, and denials, ensuring smooth revenue cycle management and proper payments.
One of the biggest challenges to achieving and maintaining ambulatory surgery center (ASC) profitability is coding. ASC coding rules can be challenging to follow correctly and often change. Filing accurate claims with proper coding is paramount to ensuring correct billing and avoiding missteps and errors that could lead to payment delays, denials, and compliance complications.
That said, following some best practices can help simplify coding. With this in mind, let’s explore why coding can be complicated for ASCs, how to fix coding errors, and how to enhance ASC billing and coding processes to streamline revenue cycle management.
The complexity of ASC coding is not to be underestimated. Effective coding demands professionals with specialized skills and thorough training. For starters, commercial payers may have their own coding rules for ASCs, which can differ from Medicare rules. In addition, codes are often expanded to include new procedures and specialties and are frequently updated for regulatory purposes.
For example, Medicare billing and coding rules for micro-invasive glaucoma surgery (MIGS) were updated on November 17, 2024. The original rules were established in 2019 and revised twice — once in 2021 and again in 2022 — before being finalized in 2024. This is just one example of many evolving rules that ASCs need to stay current with to better ensure compliance and accurate billing.
Failing to stay informed on important updates could lead ASC staff to rely on outdated coding guidelines. This can have significant ramifications on revenue cycle performance, leading to issues such as increased denials, incomplete payments, or missed opportunities to bill for high-cost items in an ASC. When staff are unaware of updates, they may unknowingly enter incorrect codes until the mistakes are identified. At that point, the errors must be corrected and resubmitted—provided it’s not too late. Undetected coding mistakes can lead to a costly cycle of delays and denials, putting unnecessary pressure on profitability.
Additional obstacles to proper ASC coding and reimbursement include:
A lot needs to go right for ASC coders to execute their work effectively. Accurate coding relies on precise dictation, transcription, and comprehensive surgeon operative notes that include all essential details. Staff must be trained in the correct usage of modifiers and how to sequence codes correctly to avoid errors. Unlisted codes should be used cautiously, as they often require additional documentation and may lead to denials if their use is not properly justified. Payer policies regarding the acceptance of unlisted codes can vary, making them less reliable.
One of the first steps to overcoming common coding obstacles and avoiding coding errors is to identify where things are going wrong in your ASC billing and coding processes. Is staff relying on outdated manuals? Are modifiers being applied incorrectly? Is coding specificity lacking?
Once a problem is identified, ASCs can develop and execute a strategy to solve the most rampant issues. But how does the identification process work?
ASCs have a few options at their disposal to find coding issues requiring attention.
Monitoring tools help track coding and billing performance over time and on an ongoing basis. When a coding change is made but missed by staff, such tools can help catch mistakes early, providing an opportunity to fix them before problems accumulate. When an issue is identified across multiple staff members, it creates an opportunity to implement targeted training, helping to prevent similar errors in the future.
Audits are another option. To measure the success of educational efforts, use key performance indicators (KPIs) around coding accuracy and compliance with payer-specific guidelines. An auditing tool can track ASC coding performance against these KPIs. Based on the results, you can then set internal benchmarks targeted at areas of improvement. This is also a good way to create accountability for staff and gain a better understanding of who is meeting expectations.
Undergoing a third-party audit at least once a year can help you gain an unbiased perspective on your ASC’s coding performance. Third parties that specialize in coding assessment for surgery centers should possess deep expertise in ASC coding analysis and may notice more subtle trends and uncover issues that could otherwise be overlooked. They can also be valuable partners who can provide knowledge and guidance your ASC may be lacking.
When the third-party assessment comes back, the results can inform your ASC’s coding strategy and provide a benchmark to compare against the following year. If the results come back with no significant findings, this validates that coding performance is where it should be, offering peace of mind.
Finally, it is also worthwhile to assess denials. By doing so, you can identify the root cause behind each denial and work to ensure the trigger for the denial is not repeated. For example, you may find the primary issue is a process problem rather than a person or payer problem. Then, the appropriate corrective actions can be taken to address the problem directly.
Identifying coding errors is only the first step. Resolving them and ensuring they don’t happen again requires adhering to best practices.
Here are some tips to achieve faster and more accurate billing and coding:
The code sets used by staff must always be current to ensure coding success. Make sure your ASC has processes in place to check the accuracy and applicability of codes, implement updates, and inform staff of changes.
When significant changes are rolled out to coding and related issues like ASC payment indicators, set up a new training session and allocate time for questions from staff to ensure everyone understands the how and why of coding rules.
Outside of training sessions, it’s important that staff members have access to helpful resources to support the completion of their work. Consider creating a resource repository where you can store manuals and guides as well as other helpful resources like cheat sheets and checklists for easy access.
A comprehensive code set can be a guiding light for coders. Such documentation needs to be maintained and updated, but it can be a quick reference for ASC coding rules. Within it, you can identify codes for your ASC's approved procedures and explain how, when, and why to use unlisted codes, how to use codes in sequence, and how to code to the highest proper level.
Since modifiers can vary for each payer, it’s worth creating documentation specific to modifier rules. Lay out which modifiers to use, where to note them on forms, and which ones your payers expect.
Accurate ASC billing and coding rely heavily on the information coming from surgeons. As such, collaborate with your surgeons to emphasize this importance and help them develop dictation processes to capture all relevant details with every procedure.
Accurate billing and coding for ambulatory surgery centers (ASCs) rely on precise surgeon dictation. AI-powered dictation tools are transforming this process by reducing workloads and efficiently capturing critical details. Technologies like AI-driven speech recognition improve accuracy while cutting down the time surgeons spend on documentation. By adopting these tools, ASCs can streamline workflows, boost financial performance, and enhance efficiency. Partnering with surgeons to implement structured dictation practices and AI solutions can improve documentation, reduce claim denials, and optimize revenue management.
While submitting codes quickly can keep the revenue cycle moving fast, it’s never worth racing documentation without checking to make sure the details are right. Encourage your coding team to double-check their work before submitting claims.
Monitoring and auditing tools, as well as third-party assessments, are key to understanding how accurate and efficient the coding system is. Without tracking performance, you may miss opportunities for improvement.
Since codes can change frequently and differ from payer to payer, the best practice is to assume you don’t know the right code and double-check codes before submitting.
ASC coding is undeniably complex, demanding significant time, effort, and resources to train staff, develop expertise, and maintain compliance on an ongoing basis. However, you don’t have to take on this burden alone. ASCs can often strengthen their coding performance by putting coding or their entire revenue cycle in the hands of an expert ASC team with certified coders. Doing so can help optimize workflows, drive faster claim submissions, expedite collections, and streamline ASC reimbursement.
When you have a solid understanding of ASC coding best practices and how to avoid the most common errors, you can begin to develop a streamlined process that ensures coding accuracy, keeps payments flowing, and frees up your staff to focus on what they do best: delivering safe and effective surgical care.
Want to learn about how Surgical Information Systems and its Revenue Cycle Services is the coding and billing solution for ASCs nationwide? Get in touch with SIS today.