ASC billing services
Facility billing is a different discipline from professional billing — different payment groupings, different carve-outs, and separate credentialing.
What actually goes wrong
An ambulatory surgery center is not a practice that happens to do procedures. It is a facility, and facility reimbursement works on entirely different mechanics. Payment is driven by procedure groupings rather than by relative value units alone, multiple procedures in one session are subject to reduction rules, and the order in which procedures are listed on the claim changes what is paid.
Implants and high-cost devices are the largest single variable. Some are packaged into the facility payment and some are carved out and separately payable, and the rule differs by payer and by contract. A center that treats every implant the same way is either absorbing device cost it could recover or billing for items that will be denied as included.
Credentialing is separate too. The facility carries its own enrolment, its own accreditation requirements and its own payer contracts, distinct from the surgeons who operate there. A surgeon being in network does not make the facility in network, and out-of-network facility claims are where the largest balances go unresolved.
Because ASC claims are high-dollar and low-volume relative to a clinic, a single unworked denial matters far more. Follow-up has to be immediate and documented.
How we work with ambulatory surgery centers
- Facility-side coding and payment grouping expertise
- Implant and device carve-out analysis by payer and contract
- Multiple-procedure reduction and correct procedure sequencing
- Separate facility credentialing and payer contracting
- High-dollar claim follow-up with documented payer contact history
- Implant cost recovery reconciled against your purchase records
Where ASC revenue is actually won and lost
Procedure sequencing on the claim. Multiple procedures in one session are subject to reduction rules, and the order in which they are listed changes what is paid. Getting the sequencing wrong is not a denial — it is a quiet underpayment that posts as though it were correct.
Implant and device carve-outs. Some devices are packaged into the facility payment and some are separately payable, and the answer differs by payer and by contract. A center that treats them all the same way is either absorbing device cost it could recover or billing for items that will deny as included. We reconcile device billing against your purchase records so the gap is visible.
Facility network status. A surgeon being in network does not make the facility in network. Out-of-network facility claims carry the largest balances in the whole engagement, and they are the ones most likely to sit unresolved.
High-dollar, low-volume follow-up. A clinic can afford to work claims in the order they arrive. A center where a single claim is worth several thousand dollars cannot. Follow-up is immediate, documented with payer reference numbers, and prioritised by value and deadline together.
Facility credentialing is its own workstream
The facility carries its own payer enrolment, its own accreditation requirements and its own contracts, separate from the physicians who operate there. Adding a new surgeon to the schedule does not add them to the facility's contracts, and a new location does not inherit the existing ones.
We run facility enrolment and physician enrolment as two tracked pipelines, because the dates, the requirements and the consequences of a lapse are different for each.
Reporting a board can use
Case volume, net revenue per case, implant cost recovery, payer mix and days in A/R, reported by specialty line and by surgeon. A center is a capital-intensive business, and the reporting has to answer capacity and contribution questions rather than only billing ones.
How onboarding works
The same five steps whatever the size of the practice.
- 1 Free A/R analysis We review your last 90 days of claims data and show you where money is being lost. No cost, no obligation.
- 2 Proposal and scope A written scope and fee, based on your collections volume and specialty.
- 3 Systems access We connect to your EHR/PM system in read-and-write mode with a signed BAA in place.
- 4 Parallel run We run alongside your current process for the first two weeks so nothing drops.
- 5 Full handover We take the cycle end-to-end, with weekly reporting from day one.
Questions from ambulatory surgery centers
Do you handle facility as well as professional billing?
Yes. ASC facility billing uses different payment mechanics from professional billing and we run both.
Can you recover implant costs?
Where the device is carved out and separately payable under the contract, yes — reconciled against your purchase records.
Does the facility need its own credentialing?
Yes. Facility enrolment and contracts are separate from the surgeons who operate there.
Related
Where this connects to the rest of the cycle.
Revenue Cycle Management
The complete cycle, end to end, with weekly reporting and a named account lead.
See revenue cycle managementProvider Credentialing & Payer Enrollment
Payer enrollment, CAQH management, re-attestation, and contract negotiation.
See provider credentialingDenial Management & Appeals
Root-cause analysis, corrected claims, and clinical appeals filed inside payer deadlines.
See denial managementAccounts Receivable Recovery
We work aged and legacy receivables other billers gave up on.
See A/R recovery