Home | ASC Billing Services
ASC Billing Services: Facility Claims Paid by the Contract
Facility Fees, Implants and Multiple Procedures
Ambulatory surgery centers bill facility fees under rules that differ from both physician billing and hospital billing. Payment indicators, implant carve-outs and multiple procedure discounts all affect what you are paid. Billing Care Assistant handles ASC billing so every case is coded, billed and paid according to your contracts.
Common ASC Billing Problems We Fix
| Billing problem | Why it costs you | How we fix it |
|---|---|---|
| Procedure not on the ASC covered list | Medicare pays ASCs only for procedures on its covered procedures list | We check the list and payer policies before cases are scheduled |
| Implants and supplies not billed | Many commercial contracts pay implants separately when invoices are attached | We bill implants with invoices under the contract terms |
| Multiple procedure discounts applied wrong | The second and later procedures are usually paid at a reduced rate | We list procedures in the right order and check payments against expected amounts |
| Canceled or discontinued procedures | Cases stopped before or after anesthesia need modifier 73 or 74 | We bill discontinued cases with the right modifier and documentation |
| Underpaid claims missed | ASC contracts are complex, so underpayments often go unnoticed | We compare every payment with the contract and appeal shortfalls |
ASC Billing We Handle
Facility claims for every specialty
We bill facility fees for orthopedic, GI, pain management, ophthalmology, ENT, podiatry and general surgery cases. We apply Medicare ASC payment indicators, device-intensive procedure rules, multiple procedure discounts, modifiers 73 and 74 for discontinued procedures, and separately payable drugs, implants and imaging where payers allow them.
How We Keep ASC Claims Clean
Case-by-case accuracy
We verify benefits and authorization before each case, code from the operative report, and check every claim against payer contracts before it goes out. Underpayments and denials go to our denial management team, and our facility credentialing team handles enrollment and payer contracting.
Payer Rules ASCs Should Watch
Contracts drive payment
Medicare pays ASCs using its own fee schedule and covered procedures list, and the claim rules differ from hospital outpatient billing. Commercial payers may pay case rates, a percentage of Medicare or carve-outs for implants, and many require prior authorization. We load your contract terms so every payment can be checked against what you are owed.
Why Surgery Centers Choose Billing Care Assistant
Facility billing expertise
You get billers who understand ASC facility claims, contract-level payment review, and monthly reports by surgeon, specialty and payer. Want to see where your center is losing revenue? Start with a free medical billing audit, or see all the specialties we bill for.
ASC Billing FAQs
What claim form do ASCs use for Medicare?
ASCs bill Medicare on the professional claim format (CMS-1500 or the 837P electronic claim), using CPT and HCPCS codes for the facility service. Some commercial payers ask for the institutional UB-04 format instead.
How are multiple procedures paid in an ASC?
Usually the highest-paying procedure is paid in full and additional procedures are paid at a reduced rate, often 50 percent, unless the procedure is exempt from the discount or the contract says otherwise.
Are implants paid separately?
Under Medicare, most implants are included in the ASC payment, with special rules for device-intensive procedures. Many commercial contracts pay implants separately when the invoice is submitted.
Do you handle ASC credentialing and contracting?
Yes. We help with Medicare and commercial facility enrollment, payer contracting and keeping your center’s information current.
Not Sure Where Your Revenue Is Leaking?
Get a free, no-obligation medical billing audit. We review your claims, denials and A/R, then show you what to fix first.
