Out-of-State Facility
ASC services provided by an out-of-state facility require prior authorization by the insurer.
An ASC outside the state of Florida shall be reimbursed the amount mutually agreed upon in a contract between the ASC and the insurer during the authorization process.
If reimbursement is not agreed upon prior to rendering the service, reimbursement shall be the greater of:
• The reimbursement amount allowed by the Florida schedule; or
• The reimbursement amount of the state in which the service(s) are rendered.
The insurer shall disallow or adjust reimbursement for any charges that are:
• Not documented in the patient’s medical record; or
• Not consistent with the ASC’s Charge Master; or
• For services, treatment or supplies that are not medically necessary for treatment of the patient’s compensable injury or condition; or
• For services unrelated to the treatment or care of a compensable injury.
Ambulatory surgical center billing code guidelines and how to get payment from insurance. ASC denial, CPT CODES , Authorization and referral Guide. Multiple procedure, Surgical procedure tips. What to get the correct reimbursement in ASC billing setup. SNF billing Guide, tips to use correct CPT AND POS.
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