Ambulatory Surgery Centers (ASCs) provide same-day surgical care with precision and efficiency. However, billing for these services is anything but simple. With complex procedure coding, strict payer rules, device billing, multiple providers, and bundled payment structures, ASCs need specialized expertise in ambulatory surgery billing to succeed financially.

At Progressive RCM, we provide comprehensive billing services specifically designed for ASCs — ensuring timely reimbursements, regulatory compliance, and optimized revenue.

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Why ASC Billing Is Different

ASCs operate under a different reimbursement model compared to inpatient or physician billing. The Medicare ASC Payment System, multiple fee schedules, and payer-specific rules add layers of complexity.

Here are the key challenges:

1. Multiple Providers and Claims

Each case may involve a surgeon, anesthesiologist, and facility — each billed separately with different codes and rules.

2. Device and Implant Billing

Surgical supplies and implants must be billed correctly using HCPCS Level II codes, with some bundled and others separately reimbursable depending on payer policies.

3. Bundling and Global Periods

Many surgical procedures are bundled into a global payment, requiring accurate modifier usage and understanding of post-op periods.

4. High-Dollar Claims

ASC claims often involve high-cost procedures, making errors particularly costly and prone to audit.

5. Medicare ASC Rules

Medicare has strict rules for covered procedures, required documentation, and modifier application, including usage of modifier SG (ASC facility services).

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Progressive RCM’s Ambulatory Surgery Billing Services

Our expert billing team offers end-to-end RCM services for ASCs, helping you minimize claim errors, maximize reimbursements, and reduce days in A/R.

✅ Accurate Coding & Charge Capture

Our certified coders handle CPT, ICD-10, and HCPCS Level II coding with accuracy. We apply appropriate modifiers, track device carve-outs, and follow payer-specific rules for:

• Orthopedic surgeries

• ENT procedures

• Pain management

• Ophthalmology (e.g., cataract surgery)

• GI endoscopy and colonoscopy

• Plastic and podiatric surgeries

• Urology and gynecology procedures

We stay compliant with Medicare ASC Covered Procedure List and private payer rules.

✅ Claims Submission & Scrubbing

We submit clean claims within 24–48 hours and run all claims through payer-specific scrubbers to catch common denial triggers.

✅ Device and Implant Billing

We correctly apply C-codes, L-codes, and other HCPCS codes for implants and high-cost supplies, ensuring carve-out eligibility is properly claimed.

✅ Payment Posting & Reconciliation

All payments are posted and reconciled daily. We compare contracted rates with payments received to identify underpayments and initiate recovery.

✅ Denial Management & Appeals

We track and resolve denials by category (e.g., bundling, authorization, coverage) and handle appeals with supporting documentation.

✅ Pre-Authorization and Eligibility Checks

We verify insurance coverage and obtain prior authorizations for procedures to avoid denials post-surgery.

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Services We Bill for ASCs

Progressive RCM bills for a wide range of ASC specialties, including:

• Orthopedics: Joint injections, arthroscopies, fracture repair

• Gastroenterology: Colonoscopy, endoscopy, biopsy

• Pain Management: Epidural, nerve blocks, ablation

• Ophthalmology: Cataract surgery, LASIK, glaucoma procedures

• Urology: Cystoscopy, stent placement

• ENT: Tonsillectomy, septoplasty, sinus surgery

• Plastic Surgery: Cosmetic and reconstructive procedures

• Gynecology: Hysteroscopy, laparoscopy

• Podiatry: Bunionectomy, hammertoe correction

Each specialty has unique coding and modifier requirements, which our team handles with expertise.

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Our ASC Billing Workflow

1. Patient Insurance Verification
   We confirm coverage, deductibles, co-pays, and prior authorization status before surgery.

2. Charge Entry & Coding
   Services and procedures are coded using CPT, ICD-10, and HCPCS codes — with modifiers and device codes applied where needed.

3. Claim Submission
   Claims are scrubbed and submitted electronically with compliance checks for Medicare and commercial payers.

4. Payment Posting & Contract Review
   Payments are posted daily and checked against payer fee schedules to ensure full reimbursement.

5. Denial Analysis & Appeals
   Denied claims are investigated, corrected, and appealed quickly with medical records and documentation.

6. Reporting & Analytics
   Monthly revenue reports, aging summaries, denial patterns, and payment benchmarks are provided for strategic insights.

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Why Choose Progressive RCM for Ambulatory Surgery Billing?

✅ ASC-Specific Billing Experience
We understand the nuances of ambulatory surgical billing — from global periods to implant codes.

✅ Compliance with CMS and Payers
We follow the latest CMS updates, Local Coverage Determinations (LCDs), and private payer policy changes.

✅ High-Dollar Claims Expertise
We handle high-reimbursement procedures with accuracy and documentation required to prevent audits.

✅ Device & Implant Billing Support
We know how to bill carve-outs, handle non-covered items, and manage HCPCS-coded devices.

✅ Fast Turnaround and Low Denials
Our efficient workflow reduces your AR days and increases first-pass claim approval rates.

✅ System Integration
We work with EMRs and ASC software like SIS, HST Pathways, AdvantX, Nextech, and others.

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Key Metrics We Track

• Clean claim submission rate

• Claim rejection and denial rate

• Days in A/R

• Revenue per case

• First-pass resolution rate

• Implant reimbursement accuracy

• Modifier error rate

• Payer performance reports

We use this data to enhance your ASC’s financial performance and make informed decisions.

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SEO Keywords Used:

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Final Thoughts

Ambulatory Surgery Center billing is one of the most complex areas of revenue cycle management due to high-cost procedures, strict documentation rules, and payer-specific nuances. With so much at stake financially and legally, outsourcing your billing to ASC experts is not just smart — it’s essential.

At Progressive RCM, we deliver accurate, compliant, and timely billing for ASCs — so you can concentrate on surgical outcomes while we ensure financial success.