Yes, it’s time to upgrade your ASC EHR if it can’t pull real-time implant costs from your OR log, can’t separate facility fees from professional fees cleanly, or can’t support ASCQR reporting without manual workarounds. Most ambulatory surgery centers don’t replace an EHR because of a single failure. They replace it because case volume grew […]
ASC claim denial rates are climbing in 2026 because prior authorization policy changes, revised NCCI bundling edits, and implant documentation requirements tightened simultaneously — and most ambulatory surgical center billing workflows were not updated to match, creating a compounding denial backlog that will reach maximum AR aging damage by Q3 if root causes are not […]
Here are the Top 10 ASC Billing Companies (2026): Medical Billers and Coders (MBC) Surgical Information Systems (SIS) R1 RCM Coronis Health Optum GeBBS Healthcare Solutions Athenahealth Greenway Health AdvancedMD Kareo / Tebra Why ASC Billing Requires a Completely Different RCM Framework Ambulatory Surgery Center billing is structurally different from physician group billing in three […]
Yes —Facility fee undercoding is the single largest revenue leak in most ASCs — generating $280,000–$480,000 per 12 months in avoidable loss per facility, with no denial ever triggering a review. The reason it stays invisible is structural. ASC billing teams apply physician billing logic to facility fee claims, misassign CMS payment groups on high-acuity […]
ASC billing is not physician practice billing performed in a surgical setting. It is a distinct revenue cycle discipline built on the CMS Ambulatory Payment Classification (APC) system — a facility-fee reimbursement structure with its own code logic, implant documentation requirements, and payer coverage policies that differ fundamentally from the RBRVS-based physician fee schedule that […]
Yes—California ASCs are accepting site-of-service reimbursement cuts of $680–$2,400 per procedure they could fight because commercial payers downgrade ASC facility fees to hospital outpatient rates, apply arbitrary “site neutrality” policies without contract language supporting them, and deny implant pass-through costs claiming procedures should transfer to physician offices when ASC contracts explicitly guarantee higher facility fee […]
Yes—Illinois ASCs losing revenue on complex cases totals $320,000–$780,000 per 12 months when facilities bill base surgical rates for high-acuity procedures, miss complexity modifiers that trigger premium payments, and fail to capture separately billable implant costs creating systematic underpayment on the 35–48% of procedures exceeding standard complexity thresholds. Complex cases—multi-level spine fusions, bilateral joint replacements, […]
Yes—implant cost gaps are draining ASC margins by 12–28% when facilities pay suppliers $1,200–$8,400 per case for orthopedic implants, cardiac devices, and spine hardware but fail to bill patients or insurers for these costs, creating negative margin procedures where surgical fees barely cover overhead while implant expenses generate pure loss. Ambulatory Surgery Centers performing 200–500 […]
Your Texas ASC’s AR over 90 days won’t convert because ASC payer variance in Texas means different payers have different timely filing deadlines—and most claims at 90+ days have already passed those deadlines. Once expired, no appeal or collection effort can recover that revenue. Understanding ASC Payer Variance in Texas: The Deadline Problem ASC payer […]
ASC margins are shrinking in 2026 despite record case volume because costs are rising faster than reimbursement across four simultaneous pressure points: anesthesia stipend requirements now affecting 44% of ASCs, medical supply chain costs projected to increase 2.41%, a CMS payment update of only 2.6% against a 3.3% market basket — and prior authorization requirements […]
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