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News, data, & insights about workers' comp billing

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Ambulatory Surgical Center (ASC) Billing for CA Workers’ Comp Now Available

April 9, 2018 by Catherine Montgomery

July Digest DaisyBill NewsInstitutional billing for California workers’ comp can be a real pain in the ASC. We just made it a whole lot easier.

After exhaustive research, hours of programming, and thorough testing, our Billing Software now includes complete billing for ambulatory surgical center (ASC) services. All DaisyBill Billing Software clients can quickly generate compliant UB-04’s, complete with bill tracking, easy second review appeals, and more.

Providers can sign up for a free demonstration here.

Complex Calculations

The hospital outpatient department/ASC fee schedule is complex even by Official Medical Fee Schedule (OMFS) standards.

According to Labor Code 5307.1, reimbursement for services provided in a hospital outpatient department cannot exceed 120% of the Medicare fee for the same services. Meanwhile, reimbursement for ASC services cannot exceed 80% of the Medicare Hospital outpatient fee schedule.

You read that right: ASC reimbursements are not calculated based on Medicare’s ASC fee schedule. Instead, ASC reimbursements are calculated based on Medicare’s hospital outpatient fee schedule, only at a different percentage than that for hospital outpatient services.

The outpatient/ASC fee schedule spans California Code of Regulations (CCR) codes 9789.30 through 9789.39. Calculating ASC reimbursements requires navigating many factors, including:

  • The Ambulatory Payment Classifications (APC) relative weight
  • County-based wage adjusted conversion factors
  • Conforming reimbursement amounts to Medicare’s (frequently updated) Addendum B based on the date of service
  • Status indicators, like the notorious J1 and C-APC
  • A slew of other fee-affecting conditions which can reduce or preclude reimbursement

If it sounds convoluted, that’s because it is. It gets so complicated, sometimes it seems like even the Division of Workers’ Compensation (DWC) can’t keep up.

ASC billing is one of the best examples of why specialized, accurate workers’ comp billing software is a must for California providers. DaisyBill clients have already submitted thousands of ASC bills and enjoyed lightning-quick payment times; our biggest payor of institutional bills by volume, Gallagher Bassett, pays in just under 7 days on average.

To see just how much easier ASC billing can be, sign up for a free demonstration today.

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DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

Drop us a line with any news you would like us to share or any issue that concerns you.

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