Ambulatory Surgery Center Billing Specialists
ASC Billing Services: Your Facility Claim, Paid Correctly
Your center's entire revenue rides on the facility fee - the payment for the room, staff, and supplies that made the case possible - and that claim is separate from every surgeon who operates in your ORs. We run the facility side so your center collects everything each case is worth, from approved-procedures eligibility to implants to multiple-procedure sessions.
One operating day
The facility fee is the easy part. What gets missed is the implant or the supply that went in with it, billed separately or not at all.
Common Challenges in Surgery Center Billing
Ambulatory surgery centers face facility-side billing complexities that can significantly impact revenue and margin on every case that passes through the OR.
- The Facility Fee Is Your Entire Revenue, and It Lives or Dies on Its Own Claim
- Your center bills for the use of the facility while each surgeon bills their own professional claim. If the facility side is built wrong, delayed, or left to fight denials alone, the center collects nothing for a case the surgeon still gets paid on.ImpactThe surgeon still gets paid, but a mishandled facility claim means your center collects nothing for the case
- Cases That Don't Belong in a Surgery Center Get Denied Outright
- Every payer maintains a list of procedures approved to be performed and paid in an ambulatory setting rather than a hospital. Schedule a case that falls off that list and the facility claim is rejected after the room, staff, and supplies have already been spent.ImpactA case scheduled off the approved list is denied after the room, staff, and supplies are already spent
- Costly Implants Bundled Into the Facility Payment Vanish Without Documentation
- On device-intensive cases, an expensive implant is often folded into the facility payment and is only covered when the invoice and clinical documentation prove it was used. Miss that step and the center eats the full cost of the hardware.ImpactAn undocumented implant means the center eats the full cost of the hardware on its highest-value cases
- Second and Later Procedures Pay at a Reduced Facility Rate
- When more than one procedure happens in a single session, your center is paid a full facility fee on just one of them and a reduced facility fee on the others. How each additional procedure is documented on the facility claim decides whether that extra room and staff time is collected or written off.ImpactAdditional procedures in a session quietly collapse into one payment when the claim is built wrong
- The Same Case Pays Very Differently Depending on Where It's Done
- A procedure performed in your center and the identical procedure in a hospital outpatient department reimburse on different fee schedules. Without deliberate site-of-service management, your center takes cases it loses money on and misses ones it should be pursuing.ImpactWithout site-of-service management, your ORs fill with cases the center loses money on
- The Facility Claim and the Surgeon's Claim Have to Tell the Same Story
- When the center's facility claim and the operating physician's claim disagree on what was done, both trigger denials and post-payment review. Keeping the two sides coordinated is constant work that most centers have no dedicated process for.ImpactWhen the facility and physician claims disagree, both are denied and pulled into post-payment review
Full-Service Surgery Center Billing
Facility-tuned billing solutions built specifically for ambulatory surgery centers and the economics of the facility fee.
Facility Fee Billing & Reconciliation
End-to-end management of the surgery-center facility claim, coordinated with each surgeon's professional claim so the two sides never contradict each other.
- Facility claim submission
- Facility-to-physician reconciliation
- Multiple-procedure sequencing
- Facility denial resolution
Implant & Device Cost Recovery
Complete billing support for device-intensive cases so expensive implants and hardware are documented and reimbursed against the facility payment.
- Implant documentation
- Vendor invoice tracking
- Device eligibility verification
- Cost-vs-reimbursement analysis
Case Eligibility & Site-of-Service Review
Pre-schedule verification against the payer's approved surgery-center procedures list and site-of-service economics so cases fill your ORs profitably.
- Approved-procedures verification
- Site-of-service review
- Case scheduling support
- Out-of-network analysis
Prior Authorization for Elective Cases
Full authorization management for elective surgical cases so approvals are secured before the case reaches the OR and the facility claim isn't denied after the fact.
- Elective pre-authorization
- Medical-necessity documentation
- Authorization tracking
- Surprise-billing compliance
How We Fix Surgery Center Billing
Our approach focuses on the revenue bottlenecks that matter most to a surgery center: the facility claim, implant recovery, case eligibility, and multiple-procedure capture.
The Facility Side Run as Its Own Discipline
A team that works surgery-center facility claims all day, so the room, staff, supplies, and recovery your center provided are captured on every case, separate from and coordinated with the surgeon's claim rather than left as an afterthought.
- Every case's facility fee built, submitted, and defended on its own
- Facility and physician claims reconciled so they never contradict each other
- Denials on the facility side worked to resolution, not written off
- Faster, cleaner payment on the claim that is your center's actual revenue
Full Recovery on Implants and Devices
On device-intensive cases the implant can be the largest cost in the room. We make sure the device cost is documented and claimed against the facility payment so it comes back to the center instead of coming out of your margin.
- Implant and device cost documented and claimed on every eligible case
- Invoice and vendor detail captured so device claims survive payer review
- Per-case device cost tracked against what each payer actually pays
- Margin protected on your highest-value surgical cases
Cases Scheduled Where They Actually Get Paid
We check each case against the payer's approved-procedures list and site-of-service economics before it hits the schedule, so your ORs fill with work that reimburses in an ambulatory setting instead of cases that will be denied or lose money.
- Every scheduled case verified against the payer's approved list first
- Site-of-service economics flagged so money-losing cases are caught early
- Approvals secured before elective cases reach the OR
- Fewer post-service denials on cases that never belonged in the center
Every Procedure in a Session Collected, Not Collapsed
When your surgeons perform more than one procedure in the same session, we build the facility claim so your center earns its full facility fee on the primary procedure and captures the correct reduced facility payment on each additional one, instead of letting that work fold into a single payment.
- Multi-procedure sessions documented so nothing gets needlessly discounted
- Each additional procedure captured at its correct facility rate
- Bilateral and same-session cases built to each payer's specific rules
- Recovered facility revenue on complex multi-procedure cases
What Each Payer Expects
Different payers have distinct requirements for ambulatory surgery center facility billing. Our billers navigate each payer's rules.
- Medicare pays surgery centers only for procedures on its approved ambulatory list, and it keeps expanding that list, so a case off the list has to move to a hospital setting or the facility claim is denied
- High-cost implants used in an approved case can qualify for payment on top of the facility rate, but only when device eligibility is verified and the cost is documented and claimed
- The facility payment is a set amount per case, so capturing every reimbursable element, including device cost, additional procedures, and supplies, is what protects the margin
- When more than one procedure is performed in a session, your center is paid a full facility fee on only one of them and a reduced facility fee on the rest, which makes how the facility claim is documented a direct revenue decision
Inside Surgery Center Billing
Why the Facility Fee, Not the Surgeon's Fee, Is Your Whole Business
Every case in your center produces two separate claims, sent by two different parties. ## Who bills what - The operating surgeon bills a professional fee - the work of their hands - Your center bills a facility fee - the room, the nursing staff, the supplies, the recovery time ## Why the surgeon getting paid tells you nothing These are independent claims. The physician's billing team has no stake in your facility claim. If your claim is built wrong, delayed, or left to fight a denial on its own, the case never pays on the facility side - even though the operation went perfectly and the surgeon was paid in full. ## What that means for your center The facility fee is not a secondary line item. It is the entire revenue of the business, and nobody outside your building is watching it.
- The facility claim and the surgeon's claim are separate and sent by different parties
- The surgeon being paid is no guarantee your center's facility claim was paid
- The facility fee is the center's entire revenue, so it needs its own dedicated process
- Coordinating the two claims prevents the contradictions that trigger denials on both
The Approved-Procedures List and the Economics of Where a Case Is Done
A surgery center is only paid for cases the payer has approved to be performed in an ambulatory setting rather than a hospital. That approved list is the boundary of what your ORs can profitably do. ## Two things about the list that catch centers out - It moves. Procedures get added as they become safe to perform outside a hospital. - It differs by payer. Approved for one plan does not mean approved for the next. Schedule a case that falls off the list and the facility claim is denied - after you have already spent the room, the staff and the supplies. ## Where the case is done also changes the payment The same procedure reimburses differently in your center than in a hospital outpatient department, because they pay on different fee schedules. That makes site of service a scheduling decision with real money attached, not an administrative detail.
- The payer's approved-procedures list defines what your center can even be paid to do
- The list changes over time and differs from one payer to the next
- The same case reimburses differently in a center versus a hospital outpatient department
- Verifying eligibility and site-of-service before scheduling prevents predictable denials
Getting Paid Back for Implants on Device-Intensive Cases
On device-intensive cases the implant is frequently the single largest cost in the room. Getting reimbursed for it is one of the hardest parts of surgery-center revenue. ## What has to line up The device cost is often folded into a single facility payment, and it is only covered when three things prove the device was used in that case: 1. The invoice 2. The manufacturer detail 3. The clinical documentation ## What happens when the trail is incomplete The payment for the hardware never arrives. Your center absorbs the full cost of an expensive implant on a case that was otherwise profitable. ## Why it needs its own process Payers scrutinize high-cost device claims closely, and they are slow to pay them. A center that cannot produce the paper trail on demand will lose these repeatedly rather than once.
- On device-intensive cases the implant is often the largest single cost in the room
- Device cost is only recovered when the invoice and clinical documentation prove it was used
- Thin documentation invites payer clawbacks on high-cost device claims
- Tracking device cost against reimbursement exposes money-losing implants and contracts
Full-Service Surgery Center Billing
Facility-tuned billing solutions built specifically for ambulatory surgery centers and the economics of the facility fee.
Facility Fee Billing & Reconciliation
End-to-end management of the surgery-center facility claim, coordinated with each surgeon's professional claim so the two sides never contradict each other.
Facility claim submission / Facility-to-physician reconciliation / Multiple-procedure sequencing / Facility denial resolution
Implant & Device Cost Recovery
Complete billing support for device-intensive cases so expensive implants and hardware are documented and reimbursed against the facility payment.
Implant documentation / Vendor invoice tracking / Device eligibility verification / Cost-vs-reimbursement analysis
Case Eligibility & Site-of-Service Review
Pre-schedule verification against the payer's approved surgery-center procedures list and site-of-service economics so cases fill your ORs profitably.
Approved-procedures verification / Site-of-service review / Case scheduling support / Out-of-network analysis
Prior Authorization for Elective Cases
Full authorization management for elective surgical cases so approvals are secured before the case reaches the OR and the facility claim isn't denied after the fact.
Elective pre-authorization / Medical-necessity documentation / Authorization tracking / Surprise-billing compliance
Ready to Fix Surgery Center Billing
Request a free surgery center revenue analysis. We'll look at your facility claim acceptance rates, denial patterns, and implant recovery to identify where your center can collect more - and by how much.