1. Pre-Op Insurance Verification
✔ Confirm patient insurance eligibility and ASC coverage
✔ Check if the procedure is covered in an outpatient setting
✔ Determine if prior authorization or referrals are needed
2. Procedure Coding & Documentation
✔ Use CPT and HCPCS codes specific to facility fees
✔ Apply correct revenue codes and modifiers (e.g., SG for ASC)
✔ Include operative reports, implants used, and supply logs
3. Claim Submission Process
✔ Submit using the CMS-1500 or UB-04 form, depending on payer
✔ Include all necessary attachments and itemized charges
✔ Track claims by payer category: Medicare, Medicaid, Commercial
4. Post-Op Billing & Collections
✔ Bill separately for facility and professional components
✔ Reconcile EOBs and payments against the original claim
✔ Address denials and rebill with corrected information promptly
5. Common Challenges & Fixes
| Challenge | Fix |
| Procedure denied as inpatient-only | Verify ASC eligibility with payer before scheduling |
| Missing documentation for implants | Attach implant invoices and usage details |
| Delayed payments from multiple payers | Track secondary claims and coordinate benefits early |
| Confusion between professional and facility billing | Separate billing teams or set clear claim responsibilities |
