For ASC billing, billing is separated into a facility fee and a professional fee. The facility fee is billed through the ASC, which is set up both as a practice and as a provider. The professional fee for the surgery/procedure is billed through the clinical practice of the surgeon/provider.
The facility (ASC) is set up and selected as the practice and the rendering provider, while the provider performing the surgery is selected as the referring provider. Configuring the ASC as both a practice and a rendering provider is done in File Maintenance.
CAUTION:
It recommended that practices consult their legal advisers, and state and other regulators for setup guidance to determine whether a separate practice should be set up for the ASC or if the ASC can be included as an additional location within the provider practice.
Setting up the ASC is done in File Maintenance, in the System Master Files. Three system master files must be updated for the practice:
- Practices - add the Ophthalmology practice as an ASC to the Practices master file
- Locations - add the Ophthalmology ASC practice as an ASC Center to the Locations master file
- Providers - add the Ophthalmology ASC practice as an ASC Center Provider to the Providers master file.
Before beginning to enter patient information for Ophthalmology ASC, you must select your ASC Center in the top toolbar as both the Location and the Provider.
Note: In the case of Ophthalmology ASC, the ASC Center is selected for both the Location and Provider in the toolbar. This is done for billing purposes because the ASC Center is considered to be the Rendering Provider, and the actual surgeon is considered to be the Referring Provider.
