Facility payment only. Professional component billed separately by the physician. Rate is packaged – implants and supplies are included for most codes.
Many require separate authorization for ASC facility vs. professional services. We obtain both.
Different fee schedules, different authorization requirements, different timely filing rules.
Some payers want modifier 50 on one line. Some want two lines with modifier 50 on each. We track per payer.
We verify ASC-specific benefits – not general medical benefits. We confirm in-network status, deductible remaining, and prior authorization requirements before the patient is scheduled.
We obtain separate authorizations for facility services (under the ASC's NPI) and professional services (under the surgeon's NPI). We track auth numbers, approved units, and expiration dates.
We reconcile three documents for every case: operative report, implant log, and anesthesia record. Implants (C1776, L8699), supplies (A4550), and billable medications (J-codes) are captured before the claim is generated.
We assign CPT codes, HCPCS codes for implants and supplies, revenue center codes for facility claims, and diagnosis codes that support medical necessity per CMS ASC-approved procedure list.
We apply modifier 73 (discontinued pre-anesthesia), modifier 74 (discontinued post-anesthesia), modifier 50 (bilateral per payer rule), modifier 58 (staged procedure), modifier 78 (unplanned return to OR), and POS 24 on every claim.
We run every claim through CCI edits, payer-specific bundling rules, implant HCPCS validation, and POS verification. Rejections are returned within 48 hours with specific correction instructions.
We appeal "not a covered ASC procedure" denials with the CMS ASC-approved procedure list attached. We appeal missing modifier denials with corrected claims. We escalate to payer medical directors when necessary.
We track aging AR by payer and by procedure code. Underpayments are identified using your contract rates. Appeals are filed for any payment below the contracted amount.
We post payments daily. Denial reason codes are logged. Trends are reported monthly so you see exactly where your revenue is leaking.
We issue clear, compliant patient statements for deductibles, coinsurance, and non-covered services (cosmetic or experimental procedures). Statements include plain-language explanations and multiple payment options.
We retain documentation for every claim: operative report, implant log, anesthesia record, prior authorization confirmation, and appeal correspondence. Audit-ready files maintained for seven years.
| Metric | RCMXpert Baseline | Industry Average for ASCs |
|---|---|---|
| First-pass acceptance rate | 91% | 73% |
| Days in A/R | 32 | 58 |
| Denial rate | 9% | 21% |
| Implant capture rate | 98% | 76% |
| Modifier 73/74 accuracy | 99% | 68% |
| Appeal success rate | 80% | 35% |
Arthroscopy, joint replacement (outpatient), fracture care, hardware removal
Colonoscopy, EGD, ERCP, hemorrhoid procedures
Epidural injections, nerve blocks, facet joint injections, radiofrequency ablation
Sinus surgery, tonsillectomy, tympanostomy tubes
Hysteroscopy, D&C, endometrial ablation, laparoscopic procedures
Cystoscopy, lithotripsy, prostate procedures
Breast reduction, abdominoplasty, hand surgery
We are not just medical billing providers; we are your dedicated partners in healthcare management services. Contact us to discover tailored solutions that transcend industry standards. Whether you’re a solo practitioner or a large healthcare facility, our expertise is designed to optimize your financial performance.
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740-766-6083
info@rcmxpert.com
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