Denials in ambulatory surgery centers happen regularly, but your first-pass acceptance rate (FAPR) goals. with the right assistance. MedCare MSO's ASC billing services put specialized surgical coders, payer-contract logic, and denial management behind every claim that is designed to reduce denials and shorten time to payment on complex surgical cases.
Talk to an ASC Billing SpecialistEvery advance that brings bigger cases into your ORs, spine hardware, premium lenses, spinal cord stimulators also brings implant capture, pass-through coding, and payer-specific claim rules that generalist billers can easily miss. Working with an experienced ASC billing company can recover that lost revenue and take the administrative weight of complex surgical claims off your staff.
96%
Collection Ratio
98.5%
First Pass Clean Claims Rate
35%
Revenue Increase
35%
Reduction in A/R
These six problems appear in nearly every surgery center we assess. Here is how MedCare MSO fixes each one at the root.
The procedure is not included in the payer's policy or that year's Medicare ASC Covered Procedures List, and the denial is reported after the money is lost. Our teams check all the cases against the current CPL, LCDs, and NCDs before it reaches the OR. This gives us time to resolve coverage issues before the case reaches the OR.
Facility claims and surgeon claims are independent submissions and have independent rules. Staff trained only on physician claims mishandle both the facility and the professional side. Our coding experts specialize in facility claims and use the right forms, places of service, and modifier processes to support correct, payable claims.
Industry analysts estimate charge-capture leakage at roughly 1–3% of net revenue. Uncaptured implants are one of the biggest causes of spine, orthopedics, and ophthalmology revenue loss. MedCare MSO reconciles the materials log against every device-intensive claim, so every implant is matched to a charge line and invoice before the claim goes out.
Medicare retired the SG requirement, yet several commercial payers still consider it for payment. This makes rejections look random. MedCare MSO maintains payer-by-payer modifier rules and applies SG and POS 24 only where each payer requires them. This eliminates a significant share of those rejections.
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NCCI edits bundle services that cannot be billed separately, and multiple procedure logic reduces payment on subsequent procedures. Posting teams that cannot process this properly chase phantom payments and miss the real underpayments. MedCare MSO models both rules at posting, so legitimate reductions are recognized, and true underpayments go straight to recovery.
Payers regularly pay a lower amount than the contracted case rate, and centers that post anything that shows up miss the loss. Our team posts every payment against your actual contract terms and highlights any variance.
Our ambulatory surgical center billing services run in four stages, with clear ownership and deadlines at every step. You can outsource your entire ASC billing process to us or hand us a single process that is holding you back.
We confirm coverage and authorization before scheduling. That includes checking each case against the two 2026 CMS pre-service review programs that may apply — the ASC Prior Authorization Demonstration and the separate WISeR Model — since a center's state and service mix determine which one governs.
Our certified surgical coders review the operative report and then assign the proper CPT, HCPCS Level II, and ICD-10-CM codes. We also categorize implants and devices and match them with the invoices payers need for separate pass-through payment.
Our team checks each claim against payer-specific requirements. Our checks include the correct claim form, CMS-1500 or UB-04, modifier requirements such as SG when applicable, POS 24, NCCI edits, and multiple-procedure payment rules.
We post payments that fit your contracted reimbursement terms instead of just accepting any amount sent by the payer. In case of any difference, we highlight the underpayment for recovery. We go one step further to trace the root cause of any denied claim through our denial management services .
Our certified surgical coders turn operative documentation into clean and defensible claims. Here is what it means:
We code from the operative report instead of the superbill to know the full story behind the claim. If the documentation is unclear or incomplete, our coders send the surgeon a query and wait for an explanation before the claim is built.
Each CPT code carries a payment indicator and it decides whether the code pays separately or folds into the primary procedure. We confirm the status of every code before submission and calculate the payment you should expect.
For each payer type, we apply modifiers 59, LT, and RT according to its guidelines. When a commercial payer requests modifier 51, we use it, because Medicare automatically adjusts payments for multiple procedures.
Device-intensive procedures need two things before a payer will release separate payment. The claim must carry the correct C-codes with an attached invoice. We handle both conditions for any device-intensive procedure. Before the claim leaves our office, we run a final review against the payer's requirements.
Want these controls run against a sample of your recent claims?
Request a ConsultationEven a good coding team can still lose money on technically sound claims. Even the correct code with an inadequate diagnosis can sometimes not be enough to justify the payer’s coverage policy. Similar quiet failures cost your center more than the more evident ones.
We have built our ambulatory surgical center billing services to catch such errors before they cost you anything. Problems get fixed in scrubbing, where they cost minutes, instead of surfacing as denials, where they cost weeks.
| Element | What it does | What do we do with it |
|---|---|---|
| CPT | Identifies the surgical procedure on the facility claim | We track annual updates and check every code against the current Covered Procedures List |
| HCPCS C and L codes | Bill implants, devices, and pass-through items separately | We capture every device charge and attach the invoice documentation payers demand |
| ICD-10-CM | Establishes medical necessity against LCD and NCD policy | We match the diagnosis to the coverage policy before the claim goes out |
| CMS-1500 (837P) | Carries Medicare ASC facility claims under Part B, POS 24 | We submit Medicare claims on the right form with POS 24 applied |
| UB-04 (837I) | The institutional form many commercial payers require | We handle revenue codes and form fields that physician-side billers have never touched |
Each specialty runs its own kind of caseload, so our ambulatory surgical center billing services are staffed by coders trained for that specific work.
The multispecialty ASC performs many procedure types under a single roof, with payers' rules (standardize to ‘payer’ throughout).
GI and endoscopy centers are high-volume and hinge on the screening-versus-diagnostic coding distinction. They depend on the screening-versus-diagnostic coding distinction and high claim volume. These centers are supported by our gastroenterology billing services .
The orthopedics and spine specialty deals with device billing the most since it includes different documents involved in the billing process.
Cost structure for IOL procedures, premium lens patients’ contributions, and a large number of surgeries on the same day result in the complexity of Ophthalmology billing. We assist such medical institutions in receiving their money.
Epidural steroid injections, spinal cord stimulator implants, and the largest number of authorizations needed in ASC including the procedures covered by the use of WISeR technology in some states.
Single-specialty centers like ENT, urology, OB/GYN, and others, including out-of-network billing strategy where contracts are thin.
Billing is one process of a revenue cycle starting at the operating room and ending at a rightfully contracted payment. MedCare MSO follows the whole process.
HealUs is the EHR that captures surgical notes for claims and works seamlessly with our medical billing services.
Salus provides us with the surgery note at the time of the surgery; hence, our coders work with the full note. Explore the AI scribe.
With the help of artificial intelligence, Sophus suggests possible codes, and certified coders have to approve the suggestions before sending a claim. See AI coding.
Maximus brings scheduling, eligibility, and claims together in one practice management system, or we work inside the system you already own.
All the components described above are available as a full set or a separate piece of software. Either way, your ambulatory surgical center billing services follow the same process from the operating room to a correctly contracted payment.
As an ASC billing company, we provide services that stay aligned with billing and security regulations. We also account for separate workers' compensation billing requirements. MedCare MSO maintains SOC 2 Type II–assessed security controls.
Our team monitors annual updates regarding OPPS/ASC, CMS payment changes, payment coding for ASCs, and Covered Procedures Lists. In CY 2026, CMS added 289 procedures to the ASC Covered Procedures List, and there was a 2.6% update in ASC payment rates, which started on January 1, 2026. In this instance, it should be noted that CMS has made separate changes to its list of inpatient-only services in hospitals.
We also support ASCQR reporting, apply NCCI edits during claim scrubbing, and maintain documentation for payer and regulatory reviews. When it comes to physician-owned ASCs, we pay attention to the Stark Law, Anti-Kickback Law, and False Claims Act so as to minimize the risk of errors in reimbursement payments.
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ASC billing covers the facility fee a surgery center earns for a procedure: the OR, nursing, supplies, implants, and recovery. It is separate from the surgeon's professional fee and follows its own CMS payment system, Covered Procedures List, claim forms, and modifiers. A specialized ASC billing company handles that facility side apart from the physician claim.
ASC Billing services encompass the complete billing process for ambulatory surgery centers, including coding, submitting claims electronically, posting payments, and properly managing denied or unpaid claims. Proper ASC billing contributes to fewer claim denials, better cash flow, and compliance with both CMS and payer regulations.
SG is the modifier for ASC facility services. Medicare decided not to require this modifier on claims for ASC facility services that took effect from January 1, 2008, and onward, but certain insurers still expect it to be there as it is related to ASC payment policy.
A case rate is a negotiated payment that takes care of all expenses incurred during the course of treatment, regardless of all its aspects. This is widespread in several commercial arrangements that involve ASC billing and allows for a whole new approach in filing and processing claims.
Commonly cited industry pricing generally ranges between 3 and 7 percent of collections. It can also be based on setup fees, varying by case volume, specialty mix, payer mix, and the scope of services included.
Yes! Medcare MSO can efficiently integrate with the majority of EHR (Electronic Health Record) and PMS (Practice Management Systems) systems used by ambulatory surgery centers, enabling them to maintain a seamless workflow and an efficient revenue cycle.
