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ASC Billing & Hospital Outpatient Billing – Understanding The Differences

Medical billing consists of hundreds of pages of updated rules, regulations, and legislation, not to mention thousands of billing codes. And, navigating them is already a challenge for practices.

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ASC Billing & Hospital Outpatient Billing – Understanding The Differences

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  1. ASC Billing & Hospital Outpatient Billing – Understanding The Differences Medical billing consists of hundreds of pages of updated rules, regulations, and legislation, not to mention thousands of billing codes. And, navigating them is already a challenge for practices. Over the last few years, patients and insurers have continued to pressure the health system and hospitals to move towards ambulatory surgery centre (ASC) billing from hospital outpatient department billing (HOPD). The reason is ASCs billing can be a cost-saving procedure. https://www.247medicalbillingservices.com https://www.247medicalbillingservices.com info@247medicalbillingservices.com info@247medicalbillingservices.com

  2. The Difference between ASC & HOPD • The primary difference between ASC and HOPD is based on the regulations that apply to the centres. For instance, a stand-alone surgery centre can still be termed as HOPD when it falls under the same administrative and financial contracts as a hospital that is within a 35-mile radius. • On the other hand, a facility can have the ASC status despite being operated by a hospital facility if it has an independent administrative and financial standing and its own agreement with Medicare. https://www.247medicalbillingservices.com https://www.247medicalbillingservices.com info@247medicalbillingservices.com info@247medicalbillingservices.com

  3. How Is Payment Different Between ASC & HOPD? • There is a difference in the methodology between ASC and HOPD operations, which leads to the payment difference. • Both use Medicare; however, when a surgery shifts to ASC from HOPD, the Medicare payment method changes to the ASC fee schedule from Outpatient Perspective Payment System (OPPS). https://www.247medicalbillingservices.com https://www.247medicalbillingservices.com info@247medicalbillingservices.com info@247medicalbillingservices.com

  4. 1. The Value System – Relative weight • The critical factor that differs between ASC and HOPD is the numerical value linked to the service provided, known as relative weight. The figures are defined by the Centre for Medicare and Medicaid Services (CMS). • The CMS uses it to reach the national allowable rate for Medicare by multiplying the value with the conversion rate. https://www.247medicalbillingservices.com https://www.247medicalbillingservices.com info@247medicalbillingservices.com info@247medicalbillingservices.com

  5. 2. Change in Conversion Factor  • As mentioned in the previous point, the conversion rate is the factor that leads to the change in the pricing between the procedures done by ASC and HOPD. • The conversion factor for ASC was earlier based on the Consumer Price Index, but now it uses the hospital market basket. In addition, due to site neutrality, the change pushes for the migration of services to ASC settings from hospitals. https://www.247medicalbillingservices.com https://www.247medicalbillingservices.com info@247medicalbillingservices.com info@247medicalbillingservices.com

  6. 3. The Wage Index • Irrespective of whether it is HOPD or ASC, the national Medicare allowable rate is determined for the procedure based on the geographical wage index. It is done by calculating the average hourly wage of the labor market of a geographic location to the national average hourly wage. As a result, the wage index adjustments based on the geographic location vary between the services provided for ASC and HOPD. • Generally, the ASC’s allowable rate is adjusted by 50% compared to HOPDs by 60%. The difference in the weightage and the methodology thus impacts the payment rates between the two. https://www.247medicalbillingservices.com https://www.247medicalbillingservices.com info@247medicalbillingservices.com info@247medicalbillingservices.com

  7. How To Handle the Differences? • We understand that you are already neck-deep in keeping up with all the coding and billing changes while attending to the patients. However, understanding and calculating the difference between ASC and HOPD can be challenging for practice. Moreover, frequent changes in the rules and regulations can add to the woes.  • Let 24/7 Medical Billing Services help you with the ASC and HOPD billings. Our team of experts has in-depth knowledge of both ASC medical billing services and Hospital medical billing services and understand the difference between the ASC Billing & Hospital Outpatient Billing to ensure you have a regular flow of revenue for the procedures done. In addition, we can assure you that you will have little to no claim rejections, thus helping you focus on providing better services to the patients. https://www.247medicalbillingservices.com https://www.247medicalbillingservices.com info@247medicalbillingservices.com info@247medicalbillingservices.com

  8. Call us Today : Media Contact – 24/7 Medical Billing Services, 28405 Osborn Road, Cleveland, OH, 44140 Tel: + 1 -888-502-0537 Email: info@247medicalbillingservices.com Website:https://www.247medicalbillingservices.com/ https://www.247medicalbillingservices.com info@247medicalbillingservices.com

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