Ask Caryl: Top ASC Billing Compliance Problems

Q: What do see as the biggest billing compliance problems in most ASCs?

Caryl Serbin: The two most common problems we see are:

1. Inequity in fees. This typically occurs when an ASC lacks good financial policies and fails to adhere to their policies. These are policies that address issues such as out-of-network versus in-network patient responsibility; billing patients for deductibles, co-pays or co-insurance; and professional or courtesy discounts.   

2. Refunds. Failure to process refunds for overpayments to government and private payors in a timely manner can land an ASC in hot water. ASCs must follow 30-day guidelines for refunds to Medicare. While not all third-party payers have the same 30-day guidelines (check contract language), we recommend following these guidelines for all payors to help ensure refund deadlines are not missed.

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