Revenue Governance for High-Performing ASCs
Align payer rules and revenue intelligence to reduce leakage, accelerate cash flow, and support sustainable ASC growth without internal overhead expansion.
Align payer rules and revenue intelligence to reduce leakage, accelerate cash flow, and support sustainable ASC growth without internal overhead expansion.
Ambulatory Surgery Centers face persistent reimbursement exposures, where payer-specific ASC rules, bundled CPT structures, implant carve-outs, and prior authorization gaps erode margins. Delays in charge capture, ASC-specific coding inaccuracies, and under-managed denial workflows often translate into rising A/R days and silent revenue leakage rather than visible billing failures.
Outsource RCM’s specialized ASC billing model addresses these risks by aligning clinical documentation, facility coding, payer logic, and denial prevention into a single revenue governance framework. The result is faster claim adjudication, predictable cash flow, and defensible compliance across commercial and government payers.
For ASC leaders seeking financial clarity without expanding internal overhead, a focused billing assessment can reveal exactly where recoverable revenue is being left unclaimed, and how to correct it with measurable impact.
Establishes a payer-aware billing strategy aligned to ASC-specific reimbursement logic, contract terms, and case mix index. Reduces revenue variance and sets a predictable net collection ratio (NCR) baseline across commercial and government payers.
Integrates eligibility validation, prior authorization governance, and benefit modeling into a single pre-op checkpoint. Lowers preventable denials and write-offs by addressing reimbursement risk before the procedure occurs.
Ensures CPT, HCPCS, modifier, and implants carve-out accuracy aligned with CMS and payer-specific ASC rules. Improves clean claim rate and minimizes post-submission corrections that inflate days in A/R.
Manages end-to-end claim submission, scrubbing, and payer routing using exception-driven workflows. Accelerates adjudication timelines and stabilizes cash inflows without increasing internal billing headcount.
Applies denial root-cause intelligence and dollar-weighted A/R prioritization to systematically recover unpaid revenue, reduce denial recurrence, and improve working capital velocity across payer segments.
Validates payer reimbursements against contracted rates and expected allowed amounts. Identifies underpayments and variance trends that directly impact realized revenue and net margin.
Provides CFO-grade visibility into net collection ratio, denial yield, A/R aging, and reimbursement variance to support forecasting, board reporting, and payer strategy decisions.
Applies structured governance loops to correct performance drift, adapt to payer rule changes, and institutionalize improvements identified through revenue analytics.
Maintains compliance with CMS, OIG, and payer audit standards through documentation governance and traceable billing controls. Reduces audit exposure while preserving defensible reimbursement outcomes.
Designed as a performance partner to ASC leadership, our operating model aligns financial outcomes, regulatory assurance, and scale-readiness into a single revenue governance framework—built to withstand payer volatility, audit scrutiny, and growth without proportional cost expansion.
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