Strategies to Improve KPIs in Your ASC Revenue Cycle
                     Strategies to 
Improve KPIs in 
Your ASC 
Revenue Cycle
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Abstract
 Introduction
 ASC Billing and Coding Guidelines – an Overview
 Latest Update – ASC Payment System
 Strategies to Improve KPIs in Your ASC Billing
 Effectively monitor and measure KPIs to Improve
 About e-Care India
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Introduction
 Ambulatory Surgical Centers (ASC) are outpatient surgical centers not requiring 
patient hospitalization or the procedure duration does not exceed 24 hours from 
the time of admission.
 ASCs are standalone centers as CMS regulatory does not allow ASC and other 
medical entities such as a medical practice or physician office to operate in one 
common space unless under certain conditions. 
 As a distinct entity exclusive for outpatient surgical services, ASC must sign a 
written agreement with Center for Medicare and Medicaid Services (CMS) and be 
certified and approved by CMS as participating providers. 
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ASC Billing and Coding Guidelines – an 
Overview
 ASC services are billed on a combination of Hospital and physician billing 
form CMS 1500 for Medicare part B and some third-party carriers, while 
other payors and commercial insurance require UB04 for billing ASC 
claims.
 ASC services are coded using HCPCS Level II codes along with ICD -10 
CM in certain instances as allowed by the payors.
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Latest Update – ASC Payment System
 Effective 1st January 2021, CMS has updated various changes in the 
payment system and policies for ASCs.
 
 In the previous update for ASC in 2019 CMS included “surgery like” 
procedures outside the CPT surgical codes that meet required criteria 
to be on the ASC list. 
 Now with effect of the current payment changes in enrollment, 
utilization, case-mix changes, ASC Medicare payments for 2021 is 
expected to see an increase of $120 million approximately. 
 Let us have a broad look into some ASC new and revised code 
changes
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 HCPCS code C9053, which was effective April 1, 2020, was deleted June 
30, 2020 and replaced with HCPCS code J0791 (Injection, crizanlizumab-
tmca, 5 mg) effective July 1, 2020.[1]
 HCPCS code C9056, which was effective April 1, 2020, was deleted June 
30, 2020 and replaced with HCPCS code J0223 (Injection, givosiran, 0.5 
mg) effective July 1, 2020[1].
 HCPCS code C9057, which was effective April 1, 2020, was deleted June 
30, 2020 and replaced with HCPCS code J1201 (Injection, cetirizine 
hydrochloride, 0.5 mg) effective July 1, 2020.[1]
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 HCPCS code C9058, which was effective April 1, 2020, was deleted June 
30, 2020 and replaced with HCPCS code Q5120 (Injection, pegfilgrastim-
bmez, biosimilar, (Ziextenzo), 0.5 mg) effective July 1, 2020[1].
 HCPCS code C9754, which was effective January 1, 2019, was deleted 
June 30, 2020 and replaced withHCPCS code G2170 effective July 1, 
2020.[1]
 HCPCS code C9755, which was effective January 1, 2019, was deleted 
June 30, 2020 and replaced withHCPCS code G2171 effective July 1, 
2020.[1]
 HCPCS codes Q4227 through Q4248: The availability of an HCPCS code 
for a particular human cell, tissue, or cellular or tissue-based product 
(HCT/P) does not mean that that product is appropriately regulated solely 
under section 361 of the PHS Act and the FDA regulations in 21 CFR Part 
1271.[1]
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Strategies to Improve KPIs in Your 
ASC Billing
 Billing for ASC requires you to understand the ASC setup and its 
operating conditions under CMS regulatory. 
 Going through the above overview and latest changes will ease 
understanding billing and coding guidelines for ASC Billing. 
 Having a streamlined billing process in place will optimize the overall 
billing experience and result in improved revenue cycle management 
for Ambulatory Surgery Billing.
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Effectively Monitor and Measure 
KPIs to Improve
By closely monitoring key performance indicators (KPI) and tracking them
will help identify lags, default in the process and streamline them. Have a
checklist of KPIs as below to be tracked and monitored regularly for
consistent and improvised results.
 Closely monitor each claim and track its average bill days to ensure 
each and every claim is billed within the timely filing limit (TFL) and 
paid appropriately. Unwanted delays in billing will lead to claim denial, 
lost or reduced pay.
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 Have a track on the payment days of each insurance payer. Each 
insurance will have different payment days from the claim submission 
date, tracking it will help you understand the payment process and 
schedule follow-up if required.
 Tracking Old AR aging more than 90 days will help decrease your revenue 
loss and maintain a healthy billing process. It is ideal to make sure that 
your old AR does not cross more than 10-15%. Anything exceeding this 
can be a sign that your billing is overlooked and needs immediate 
attention and corrective measures for effective and productive results.
 Keeping a track of the denial reason and educating your billing and coding 
staff on repeated errors to reduce denial percentage.
 Outsourcing your ASC billing to an 
offshore-based Medical Billing company can help enhance your billing 
process and your monthly collections.
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About e-Care India
 e-Care is one of the top medical billing companies in India with more 
than 20 years of experience in the industry, e-Care provides end to 
end billing services to more than 80+ Clients across US. e-Care is a 
multispecialty medical billing company having expertise across more 
than 28 specialties. Our team has a clear understanding of the payer 
guidelines for ASC billing in various states. To know more about our 
ASC billing visit 
Ambulatory Surgical  Center (ASC) Billing Services | e-care India
Reference
 [1]
https://www.hfma.org/content/dam/hfma/Documents/industry-initiative
s/fact-sheets/cy2021-opps-asc-final-rule-summary.pdf
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