Ambulatory Surgery Billing
Implant and multi-procedure billing, bundling rules and modifier accuracy.
What it covers
- ASC facility claim preparation
- Implant and high-cost supply billing
- Multi-procedure and bilateral rules
- Modifier accuracy (50, 51, 59, XE / XP / XS / XU)
- Payer-specific ASC covered-procedure lists
- Carve-out and invoice-based reimbursement
Where practices lose money here
Implants billed without invoice support
Carve-out reimbursement usually requires invoice documentation. Without it, an expensive implant is absorbed by the facility.
Multi-procedure discounting misapplied
Getting the primary procedure wrong changes the entire reimbursement on the case.
Procedures billed off the covered list
Each payer maintains its own ASC covered-procedure list. Billing off it is an automatic denial.
How Medway handles it
- Implant and supply claims are assembled with the invoice documentation payers require.
- Primary procedure selection and multi-procedure sequencing are validated per case.
- Covered-procedure lists are checked per payer before the case is billed.
- Modifier use is validated against the specific payer's edits.
What you get
- Implant revenue that actually gets reimbursed
- Correct procedure sequencing on multi-procedure cases
- Payer-specific covered-list validation
- Fewer bundling denials
Get a free audit of your ambulatory surgery billing claims. Send us a recent aging report and we will show you, in writing, where the recoverable revenue is — no cost, no commitment.
Frequently Asked Questions
You send us a recent accounts receivable aging report and, where possible, a denial export. We review them and give you a written breakdown: where recoverable revenue is sitting, which denial reasons are costing you most, what your timely-filing exposure looks like, and the fixes we would make in priority order. It is yours to keep whether or not you work with us. Please do not include patient health information — we only need claim-level financial data.
Most of the timeline is payer enrollment and EDI setup, and neither is fully in our control — that is the honest answer. Practices already enrolled with their payers typically start seeing claims go out within two to three weeks. Where new enrollments or revalidations are needed, budget longer, because the payer sets that pace. We tell you which of the two you are in after looking at your current setup.
Solo practitioners are often the strongest case for it, not the weakest. A one-person billing office has no redundancy — a vacation or a resignation stops your revenue cycle, and the cost is not the temp, it is the AR that ages and the claims that pass their filing deadline while nobody is working them.
Access to your existing EMR/PMS, your payer list and contracts, your fee schedule, and a recent AR aging report. If you are moving from another biller, we also need clarity on who works the open AR at transition — that is the single most commonly mishandled part of a billing switch.
