Wednesday, September 14, 2016

Billing guideline for Non ASC services under ASC setup

Services Furnished in ASCs Which Are Not ASC Facility Services or Covered Ancillary Services 

A single payment is made to an ASC for facility services furnished by the ASC in connection with a covered surgical procedure. Additional payments may be made to the ASC for covered ancillary services, specifically brachytherapy sources, certain implantable devices with pass-through status under the OPPS, corneal tissue acquisition, drugs and biologicals for which separate payment is allowed under the OPPS, and radiology services for which separate payment is allowed under the OPPS. To be covered ancillary services for which separate payment is made, these items and services must be provided integral to covered surgical procedures, that is, immediately before, during, or immediately after the covered surgical procedure.

However, a number of items and services covered under Medicare may be furnished in an ASC which are not considered ASC services, and which payment for ASC services does not include. These non-ASC services are covered and paid for under the applicable provisions of Part B. In addition, the ASC may be part of a medical complex that includes other entities, such as an independent laboratory, supplier of durable medical equipment, or a physician’s office, which are covered as separate entities under Part B. In general, an item or service provided in a separate part of the complex is not considered an ASC service, except as defined above.

Examples of payment and billing for items or services that are not ASC services:

Items not included in payment for ASC services Who may receive payment

Physicians’ services (including surgical procedures excluded from ASC payment)

The purchase or rental of non-implantable durable medical equipment (DME) to ASC patients for use in their homes Supplier-
    An ASC can be a supplier of DME if it has a supplier number from the National Supplier Clearinghouse.

Non-implantable prosthetic devices
   Supplier. An ASC can be a supplier of non-implantable prosthetics if it has a supplier number from the National Supplier Clearinghouse.

Certified Ambulance supplier

Leg, arm, back and neck braces

Artificial legs, arms, and eyes

Services furnished by an independent laboratory
Certified lab. ASCs can receive lab certification and a CLIA number.

Facility services for surgical procedures excluded from the ASC list

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