The delivery of eye care services has undergone major changes in recent years. Several broad economic and political trends have encouraged practitioners to re-examine the traditional medical delivery systems. These include: political initiatives to control the cost of health care, growth of managed care, hospital mergers, consolidation of physician practices, and the proposed ambulatory payment groups. To adjust to these forces, physicians are compelled to diversify; some consider vertical integration that includes the addition of an ambulatory surgery center (ASC).

An efficiently run ASC provides significant benefits to a practice. Patient satisfaction is high because of convenience. Surgeons also enjoy the convenience as well as an additional revenue source. An ASC will be profitable if it is well designed, efficient, and has the caseload to support it.

While billing for ASC services is certainly less complex than billing for physician services, there is a great deal to know to ensure compliance with medical necessity, coding and documentation requirements. Attention to detail is required in completing and submitting claims for reimbursement and maintaining patient medical records.

This monograph contains a detailed discussion of billing for services performed in an ASC. This includes:

• Facility Fee Reimbursement
• Coverage Criteria
• Payment Groups
• Multiple Procedures
• National Correct Coding Initiative (NCCI)
• New Technology IOLs
• Ambulatory Payment Classifications
• Assignment of Benefits
• Relevant Forms
• Claim Form Completion
• Surgical Modifiers
• Reimbursement of Supplies