Monday, April 25, 2016

What are the document required to Maintain in ASC for insurance payment

Medical Records for Reimbursement

Disclosure to Carriers

At a minimum, it is the responsibility of the ASC to furnish, without charge, the following  documentation to the insurer with the ASC bill:

• An operative report when a surgical procedure is performed; and

• Surgical Implant(s), Associated Disposable Instrumentation and Shipping & Handling Invoices, when applicable; and

• Any copies of medical records required by the employer or carrier, that the provider received written notification from the employer or carrier as being a required component for reimbursement, when the services were authorized. Failure of the provider to forward additional information, when requested by the employer/insurer at the time of authorization, may result in the billed service(s) being disallowed or denied for payment until sufficient documentation is provided to render the necessary determination.

Verifying Accuracy of Charges, Medical Necessity or Compensability

An ASC shall produce, or make the documents available for on-site review, of the relevant portions of the ASC Charge Master and any and all applicable medical records when requested by the Division, by an insurer or by its’ designee, as part of an on-site audit to verify accuracy of the ASC charges, billing practices, or medical necessity and compensability of charges for medical services and supplies.

An ASC shall produce copies of requested documents, or make the documents available for on-site review, within thirty (30) days of receipt of the written request from the Division, an insurer or its designee to conduct a review or audit.

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