Healthcare practice guide
Billing, Books, and Payroll for Ambulatory Surgery Centers
Implant cost recovery, prior authorization, and case-level margin you can actually see.
An ASC lives on case margin, and case margin dies on two things: implants and devices billed below acquisition cost, and prior authorizations that did not cover the procedure actually performed. Both are knowable before the case, which is where we put the controls.
Your practice
Set once — every healthcare tool below pre-fills from it and it stays with you for this visit.
- Clean claim rate target
- 96%+
- Days in A/R target
- Under 40
- Implant margin
- Positive per case
Case volume is low, so each denial matters more
Commercial-heavy centers should settle faster
Acquisition cost against expected reimbursement
Where the money leaks
Implant and device carve-outs
High-cost implants bundled into a rate that does not cover acquisition. We track invoice cost to reimbursement per case.
Prior authorization mismatch
Authorization obtained for the planned CPT, then a different procedure performed. The claim denies for a covered service.
Out-of-network balance handling
No Surprises Act rules changed the process. Mishandled disputes forfeit the amount entirely.
How we run it
- 1
Pre-case financial clearance
Benefits, authorization, and patient responsibility confirmed before scheduling the case.
- 2
Implant cost tracking
Invoice cost matched to expected reimbursement so negative-margin cases are flagged before, not after.
- 3
Case-level coding
Coded from the operative note, with authorization reverified against the procedure actually performed.
- 4
Payer dispute handling
Independent dispute resolution timelines tracked to the day.
- 5
Case margin reporting
Margin by procedure, surgeon, and payer, updated with the monthly close.
Payers we bill every month
- Commercial PPO plans
- Medicare
- Workers' compensation carriers
- Medicare Advantage
- Self-pay and package pricing
State rules we work under
Medicaid programs, payer portals, and payroll rules change at the state line. Pick your state for the specifics.
AHCCCS (Arizona Health Care Cost Containment System) · Phoenix, Scottsdale, Mesa
State billing detailMaineCare · Portland, Bangor, Lewiston-Auburn
State billing detailNJ FamilyCare · Newark, Jersey City, Princeton
State billing detailNorth Dakota Medicaid · Fargo, Bismarck, Grand Forks
State billing detailOregon Health Plan (OHP) · Portland, Salem, Eugene
State billing detailApple Health · Seattle, Bellevue, Tacoma
State billing detailTexas Medicaid · Houston, Dallas–Fort Worth, Austin
State billing detail