Medical billing to Medicare is extremely complicated. This is why medical billers and coders are their own profession in the health care industry. Here is a look at general surgery center medical billing or ambulatory surgical center (ASC) billing by MedicalCodingCert.
Ambulatory Payment Classifications
Ambulatory payment classifications or APCs influence medical coding, taking what happens to a patient and turning that into a formula to bill Medicare.
APCs keep Medicare costs down, although not necessarily hospitals’ or care centers’ costs down. The theory is that this system would make hospitals and care centers work more efficiently so they would not lose money on Medicare patients. Unfortunately, there are no national guidelines as to how these codes work. Billing can be from hospitals or other medical centers that have contracts with Medicare.
What are Status Indicators?
Medicare gives each procedure they are billed a status indicator. This is a fancy way of saying whether they will pay for the procedure or not. Indicators also indicate if the procedure is part of a bundled package. Procedures need to be coded even if they have no cost. One of the most frequently used status indicators for outpatient services is “N”, which means the procedure is part of a bundle and no separate bill for that procedure will be accepted.