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J U LY 2 0 1 5 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
But if that's the case, what's the best way to submit ASC services on
the claim form? A good place to start is the Medicare Claims
Processing Manual, found in Medicare's Internet-Only Manuals (publi-
cation number 100-04, chapter 14, osmag.net/XdVn9S). This manual acts
as the primary resource for ASC claims processing, though not every-
thing is spelled out clearly in the manual.
To supplement this information, turn to your Medicare contractors.
CMS uses a network of contractors called Medicare Administrative
Contractors to process Medicare claims, educate providers on
Medicare billing requirements, handle appeals and answer beneficiary
and provider inquiries. Part B MACs, which have jurisdiction over a
particular geographic area, may have local determinations that result
in additional policy or billing instructions.
If your ASC is performing or considering performing spinal cases,
contact your MAC to determine how you may be reimbursed and how
the MAC processes claims. They could tell you, for example, if there
are additional billing instructions for your area.
With these cases, you should also keep in mind the patient's respon-
sibility for codes not covered by Medicare. Be sure to review non-cov-
ered codes and notify your patient before the procedure, since he
would be responsible for non-covered charges.
In situations where you expect Medicare to deny the payment, you
should issue the Advanced Beneficiary Notice of Noncoverage (ABN)
Form CMS-R-131 to the patient. There are specific guidelines available
in the Medicare Claims Processing Manual (chapter 30, section 50) to
help you determine if and how you use the ABN.
Future considerations
While the current spine codes are a good start, there's more to be done.
It's probably not economically feasible to perform many of the
