Ambulatory Surgery Center Payment System
___ covers outpatient and physician-based ambulatory services.
Medicare Part B
Payment rates are based on rates set under
Medicare Part B
The revenue cycle starts with
patient registration/scheduling
After payment is received by the insurance provider, you should
review the RA
NCD stands for
national coverage determinations
Providers are reimbursed using the
Medicare Fee Schedule
The payment rate for each service is calculated by multiplying the relative weight for the applicable APC by the ASC
conversion factor
__ ensures that a service will be covered before it is performed.
preauthorization
What type of patient is responsible for the entire bill?
self-pay patients
Modifier 73 is for
Discontinued after preparation for surgery
Which code set is for procedures?
HCPCS
related services are bundled together and paid in one lump sum
"packaged"
medically necessary
__ is a fixed amount of money per patient per unit of time paid in advance to the ASC for the delivery of health care services.
capitation
Medicaid requires the use of modifier _ which identifies the claim as an ASC claim
SG
Medicare will not pay for surgical procedures if they are on the
ASC exclusion list
HOPD claims to the payers are filed using the
Uniform Bill 04 (UB-04)
EMR stands for
electronic medical records
_ is a payment type in which the provider is paid per service.
fee-for-service
Modifier LT is for
left side
Payments for most physicians' services are determined by the standard system for pricing called the
resource-based relative value scale
Ambulatory surgical center claims are submitted to Medicare and Medicaid using the
CMS-1500 form
ECS stands for
electronic claims submission
The _ is used for billing hospital ASC surgery
Ub-04
Modifier TC is for
technical support