4 Things You Need To Know About Ambulatory Surgery Center Billing

Posted on: 2 May 2023

Ambulatory centers have grown rapidly over the past years, with many patients opting for outpatient procedures. While ambulatory surgery centers offer many benefits, they also present unique challenges for hospital administrators in terms of billing, with many nuances that can affect the bottom line. Here are four things you need to know about ambulatory surgery center billing to ensure your facility collects payments accurately.

1. Bundled Payments

Unlike hospitals, ambulatory surgery centers have a different way of billing patients. They often rely on bundled payments, which means charging for an entire procedure instead of billing individual services or treatments. Insurance companies have specific procedures that ambulatory surgery centers can bill under a bundled payment system. These rates are usually cheaper than hospital rates, but it's important to understand the costs and projected revenue to ensure profitability.

2. Facility Fees and Professional Fees

When payments are not bundled, ambulatory surgery center billing often includes separate line items for facility and professional fees. In other words, one fee for the cost of using the center's facilities and equipment and another for the surgeon's or anesthesiologist's services. While these fees can be frustrating for patients, they are also difficult to track and manage. It's important to ensure that all services are accurately billed to reduce the risk of lost revenue.

3. Insurance Verification

Ambulatory surgery centers may be considered out-of-network providers by some insurance companies. It's critical to verify patients' insurance to ensure they are covered for services provided by the center. Failure to verify insurance could result in unexpected financial losses for both the patient and the center.

4. Regulatory Compliance

Ambulatory surgery centers must comply with multiple regulations to ensure they receive timely and accurate payments. For example, they must meet federal and state requirements for data management, privacy, and security. Centers must have clear policies on data management and handling, and staff should be trained regularly on these policies to ensure compliance. Non-compliance with regulatory policies can result in penalties, loss of accreditation, and potential loss of patients who seek care elsewhere.

While ambulatory centers offer a multitude of advantages to patients, ensuring correct billing and robust revenue cycle management requires a level of expertise. Hospital administrators need to familiarize themselves with ambulatory billing procedures and ensure that their facility is at the forefront of regulatory compliance. By understanding the nuances of ambulatory surgery center billing, calculating cost and potential profitability becomes easier.