Ambulatory Surgery Centers billing and accounts receivable

ASCs live and die on the payable-procedure list, implant carve-outs and multiple-procedure reductions.

Where the money leaks in ambulatory surgery centers

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• Procedure not on the ASC covered list for that payer
• Multiple procedure discounting applied incorrectly
• Implants denied for missing invoice or carve-out language
• Facility and professional claims crossing and cancelling each other
• Prior authorization obtained for the surgeon but not the facility

What a seat does about it

One trained person works your queue from the difficult end. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing.

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and certified coding at $2,500.

The codes those turn into

Each of these is a denial code you are likely to meet working ambulatory surgery centers, matched to the problem above it in your own words. The route back to payment differs by code, so a queue sorted by recovery route clears faster than one sorted by date.

• CO-197 — Prior authorization absent
  The payer required prior authorization for this service and cannot find one attached to the claim.
  Recovered by being taken back to the authorization. Matched from: “Prior authorization obtained for the surgeon but not the facility”

Working a denied claim costs $57.23 per denied claim in administrative time (source), and about about 90% of initially denied claims are eventually paid. Most of what sits in a ambulatory surgery centers AR bucket is not lost money. It is money waiting for somebody with the hours to make the call.

Questions