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Ask-A-Consultant: ASC Global Billing

Q:

Can an ASC that does global billing also charge for high cost disposables? If so, what kind of codes are used for billing purposes?

A:

In a global billing environment, in some limited circumstances, you can bill for high-cost disposables by using specific, or when not available, miscellaneous HCPCS for those items. To assure payment on these items, it always is best to negotiate these items up front with each specific carrier.

The other way in which you can recoup your costs for such disposables is to negotiate these costs into your global fee. However, if these items are the exception in your surgical cases, you will have a hard time negotiating higher global payments for such surgical cases if not all of them include these disposables. Instead, you may wish to negotiate these high-cost disposables as carve-outs to your global fees.

The most important factor to consider here is that each carrier responds differently to billing for such items outside of their global fee. You may find that some carriers will pay for such items and others not. Therefore, as mentioned earlier, it is best to negotiate in advance specific reimbursements with your primary carriers.

Medical Management Associates, Inc. has specific expertise in this area and can help you negotiate your contracts as required.
 

John F. Friedel
Senior Associate

MMA does not provide legal, accounting, or tax advice.  If you need assistance in these areas, we recommend that you consult a qualified professional.  In addition, please note that a client relationship with MMA is not established by the submission of a question to this forum or by the publishing of MMA's response.



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Medical Management Associates, Inc.
3330 Cumberland Boulevard Suite 200 Atlanta, GA 30339
Voice (770) 951-8427 Facsimile (770) 951-2157
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