Wiki New to ASC Billing

LORA CRAWFORD

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East Valley, Tempe AZ
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I am new to ASC billing and need a bit of guidance. I am in AZ and have been told that the AHCCCS claims are required to be billed on a UB-04.(?) I also read in a Medicare publication that each procedure gets a modifier of SG. Is that always the first modifier? Any bit of assistance would be helpful. Lora
 
Hi Lisa,

Welcome the the ASC world!! Claims should be billed on the UB92 (could be called the UB04 now???) Medicare did away with the SG modifier as of 1-1-08however you may find that some payors will still require it (DOL, Tricare, ect). I dont know of any commercial payors that require it but could be possible. That will be trial and error.

Hope this helps.

Good Luck :)
Mary
 
I bill most of my claim on UB-04; Medicare, Worker's Comp and Auto I bill on the cms1500 but you can also bill these on UB-04 if you have all the required information. The Modifier SG is invalid for 2008; prior to that year it was required.

hope this helps!
 
Sorry..I also bill my Medicare claims on a CMS 1500, there are a few W/C carriers (DOL) that use the 1500 as well as Tricare.
 
I am new to ASC billing and need a bit of guidance. I am in AZ and have been told that the AHCCCS claims are required to be billed on a UB-04.(?) I also read in a Medicare publication that each procedure gets a modifier of SG. Is that always the first modifier? Any bit of assistance would be helpful. Lora

Medicare dropped the SG modifier for 2008 as already stated but I use it as the first modifier for almost every other payer. There of course are exceptions to that such as radiology where you would use just a TC modifier (assuming you're just billing the technical component in an ASC...use 26 if your billing for the physician side of it). As for Tricare I bill that on a UB (with full signature!) & have never been asked to resubmit on a CMS1500 . Washington state Medicaid doesn't use the SG modifier but if billing for multiple procedures they ask you to use U1 for the first procedure U2 for the 2nd & so on.

Medicare & workers comp still require the CMS1500 for ASC's but I use the UB for most other payers.
 
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