Hospital-based ASCs fly solo on APG billings
Hospital-based ASCs fly solo on APG billings
Question: Can a hospital-based freestanding facility bill separately for procedures under APGs, or should it go through the central business office? What are the advantages of going through the hospital?
Answer: Whether a freestanding facility bills separately will depend on the way the hospital has contracted with its payer. At Blue Cross, a contracted facility receives a specific provider number that appears on each claim. The number tells our system whether to run the claim under APGs. If the facility is a freestanding ambulatory surgery center (ASC) that shares the hospital’s provider number, it should bill through the hospital. These arrangements are usually decided in advance of the final contract agreement.
The obvious advantages of going through the hospital’s business office are convenience and technological support. However, many hospital-based ASCs are doing their own coding and billing today.
There is one important advantage to that alternative: It enables the ASC to track its own financial performance under APGs and allows the ASC and the payer to measure how the surgery facility stacks up against other ASCs in the market. The hospital also may want to know how the ASC is performing compared with the hospital itself.
Blue Cross regularly profiles its contracting facilities. If everything gets billed under the same provider number, it becomes difficult to do any such reporting.
[Editor’s note: The 1997 ICD-9-CM and CPT-4 procedure codes for APGs can be ordered on hard copy or in diskette text file versions free of charge. Contact: Terry Dogali, 3M Health Information Systems, 100 Barnes Road, Wallingford, CT 06492. Telephone: (203) 949-0303.]
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