Ambulatory Surgery Centers (ASCs) operate in one of the most complex reimbursement environments in healthcare. While patient volume and scheduling efficiency often get the spotlight, real profitability hinges on how well your ASC billing and coding systems capture every reimbursable dollar.
At MBC, we specialize in identifying and fixing the revenue cycle issues that most billing vendors overlook—because they require a deeper understanding of ASC specialty services, payer behaviors, and coding compliance.
Here are the 7 most common (and costly) revenue leaks we uncover in ASC billing operations—and how to fix them.
1. Multiple Procedure Coding Errors: The Silent Revenue Killer
Multiple procedure coding ASC
In high-volume specialties like orthopedics and GI, it’s common to bill multiple procedures under a single encounter. But if coders apply modifiers incorrectly—or miss them altogether—you’ll face bundled payments or outright denials.
Example: CPT modifier 51 (multiple procedures) and 59 (distinct procedural service) are frequently applied in the wrong order, or not at all, leading to reduced reimbursement.
How MBC Fixes It:
Our certified ASC coders apply specialty-specific logic for sequencing and bundling rules, tailored to each payer’s edits and your state’s guidelines.
2. Implant Reimbursement Gaps in ASC Settings
Implant reimbursement ASC private payers
Implants are often the most expensive part of a surgical case, especially in orthopedics and spine. Yet many ASCs fail to recoup costs because payers require itemized documentation, invoice submissions, or carve-out contracts.
Problem: Private payers often don’t follow CMS implant reimbursement logic, creating confusion and unreimbursed expenses.
How MBC Fixes It:
We audit implant capture and cost pass-through workflows, ensure correct modifier use (e.g., L8699), and submit payer-required documentation upfront.
3. Payer-Specific Prior Authorization Failures
ASC prior authorization denials by specialty
Specialties like pain management, podiatry, and GI often get hit with denials—not because services aren’t covered, but because payer-specific pre-auth requirements weren’t met.
Impact: Delayed care, high-volume denials, and rescheduled cases that impact OR utilization.
How MBC Fixes It:
We manage a payer-specific PA database and integrate medical necessity checks into scheduling workflows, reducing preventable denials by up to 40%.
4. Out-of-Network Billing Complexity in ASCs
Out-of-network ASC billing strategy
Many ASCs operate partially out-of-network—especially with specialty surgeons or limited payer participation. Without an OON reimbursement and negotiation strategy, your facility faces increased patient AR and write-offs.
How MBC Fixes It:
We apply strategic pricing logic, pursue balance billing (where permitted), and manage the patient communications process to reduce collections friction.
5. Lack of Specialty-Level Revenue Tracking
Track ASC revenue by specialty
If your ASC treats multiple specialties—ENT, ortho, GI, pain—you need to track each one’s financial performance independently. Most platforms don’t support this level of reporting natively.
Problem: You can’t optimize case mix or staffing without clear insight into what’s profitable and what’s not.
How MBC Fixes It:
Our reporting platform provides real-time dashboards with specialty-specific filters, empowering administrators to make data-driven operational decisions.
6. Billing for Procedures Not on the CMS ASC-Approved List
CMS ASC list billing errors
CMS maintains a strict list of approved procedures for reimbursement in the ASC setting. If your facility bills for non-approved procedures—especially in spine or laparoscopic specialties—you risk denial or downcoding.
How MBC Fixes It:
We validate case scheduling against CMS and payer-specific procedure lists before the claim is ever submitted.
7. Front-End Staff Training Gaps in Coding & Documentation
ASC front desk coding errors
Scheduling and registration staff often aren’t trained in CPT updates, ICD-10 requirements, or documentation logic tied to reimbursement. That means errors start before the patient even walks in.
How MBC Fixes It:
We provide front-desk and scheduler training sessions focused on the latest payer rules, unlisted code requirements, and PA workflows.
The Solution? ASC Billing That’s Built Around Your Specialties
The real revenue leaks in ASCs don’t come from major system failures—they come from everyday coding, documentation, and process breakdowns that accumulate over time.
At MBC, we help ASCs:
- Reduce denials tied to specialty coding issues
- Maximize implant and OON reimbursements
- Track and improve specialty-level profitability
- Eliminate backlog from untrained front-end workflows
Schedule a Consultation Today
Let Medical Billers and Coders take a closer look at your current A/R, case mix, and payer outcomes. We’ll pinpoint exactly where your ASC is losing revenue—and how fast our ASC billing and coding experts can help you recover it.
Medical Billers and Coders | Experts in ASC Revenue Recovery
ASC Billing. ASC Coding. Strategy. Specialty First.
FAQs
ASCs often face revenue loss due to multiple procedure coding errors, implant reimbursement issues, prior authorization denials, and billing for non-CMS-approved procedures. These errors can result in bundled payments, claim denials, or unreimbursed services.
Implants are costly and often require itemized documentation, invoices, or carve-out contracts. Unlike CMS, private payers may have inconsistent reimbursement rules, leading to confusion and lost revenue if ASCs don’t follow the correct documentation and billing protocols.
Denials often occur when payer-specific prior authorization requirements aren’t met. MBC addresses this by maintaining a PA database and integrating medical necessity checks into the scheduling workflow to prevent up to 40% of avoidable denials.
Without a proper out-of-network (OON) billing strategy, ASCs risk high patient AR and increased write-offs. MBC helps mitigate this by using strategic pricing, balance billing (where permitted), and clear patient communication.
Many ASCs struggle to track profitability by specialty due to limited reporting tools. MBC provides real-time dashboards with specialty-specific filters, enabling better case mix management and financial decision-making.
