Ambulatory Surgery Center Billing Services

Check each contract for carve-out terms, then bill with invoice documentation attached. Some agreements pay high-cost implants above the facility fee, others package everything. Centres frequently absorb implant cost because nobody checked whether the contract allowed recovery. We review your agreements and pursue every carve-out available, which can transform the margin on device-heavy cases.

Because the packaged facility fee assumes a typical cost profile and some cases are far from typical. Without per-case costing you cannot see which ones. We track implant and supply cost against the payment received by procedure, which usually identifies two or three case types that should be renegotiated or reconsidered entirely.

They should be consistent, yes. When the centre and the surgeon submit different codes or dates for the same case, payers flag both claims for review and payment slows on each. We reconcile the facility claim against the surgeon's coding before either transmits, which removes a review category that otherwise delays your highest-value cases.

Additional procedures performed in the same session are paid at reduced percentages of their normal rate. That is expected. The problem is when the reduction applied exceeds what your contract permits, and the difference vanishes into a contractual adjustment. Line-level posting against loaded rates exposes it so we can appeal the variance.

Verify network status per payer and per surgeon before booking, not after. A surgeon may be in network while your centre is not, or the reverse, and either situation leaves large unexpected balances. Patients react badly to surprise facility bills. Confirming status at scheduling lets you make an informed decision before theatre time is committed.

Compare the operative report against the authorised scope before billing. Surgeons frequently do more than planned once they are operating, and the facility claim may exceed what was approved. Some payers accept a post-service notification, others do not. Catching it before submission gives you options, whereas a denial after the fact rarely does.

By recording implants and high-cost items against the case at the time of use, rather than from a monthly stock reconciliation. Theatre staff already document what was opened, so capturing cost alongside it adds very little work. That single habit makes case-level margin reporting possible, which is the most useful management report a surgery centre can have.

Yes. The centre itself must be enrolled and contracted with each payer, separately from the surgeons who operate there. A surgeon being in network does not make your facility in network. Missing or lapsed facility enrollment produces denials on every case for that payer, which is expensive and easy to overlook.

It is a third separate claim. The anesthetist bills their own service using time and base units, independently of both your facility fee and the surgeon's professional charge. Confusion arises when centres assume anesthesia is included in their package. We keep the three tracks distinct so none of them collide at the payer.

Case margin by procedure, not just collections. You need reimbursement measured against recorded cost so unprofitable case types are visible. You should also see payer-level performance, because the same procedure can be profitable under one contract and loss-making under another. That view is what drives contract negotiations that actually change the numbers.