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Ambulatory Surgery Center (ASC) Billing Services
Underpaid Facility Fees, Unbilled Implants, and Multiple-Procedure Discounts: Where ASC Revenue Goes Qualigenix bills facility claims for single-specialty and multi-specialty ambulatory surgery centers in 48 states, covering ophthalmology, orthopedics, GI, pain, urology and more. Our claims reach a 98.2% first-pass clean claim rate, and our coders work at 98.9% coding accuracy.
How ASC Billing Differs From Physician Billing
ASC billing is facility billing: the center bills for the operating room, staff, supplies and implants, while surgeons and anesthesia providers bill their own professional claims. Medicare pays ASCs from its Covered Procedures List using payment indicators and a multiple-procedure discount, and commercial payers pay by contract, often with implant carve-outs. Qualigenix bills both and checks every payment against the contract. Call 786-259-0231 for a free ASC billing audit.
01
Multi-Specialty CPT Coding
A multi-specialty center may bill cataract, arthroscopy, endoscopy and spine injection cases in one day. Each specialty has its own bundling rules, and a coder who knows one well may not know the others.
02
Procedure & Implant Auths
Commercial plans often require authorization for both the procedure and the implant. An approval that names the wrong site or CPT code can deny the facility claim even when the surgeon's claim pays.
03
Payment Indicators & Discounting
Medicare assigns each covered procedure a payment indicator and discounts the second and later procedures by 50% when they're subject to discounting. Claims sequenced in the wrong order lose the full payment on the highest-paid procedure.
04
Implant & Device Charges
Under Medicare, most implants are packaged into the procedure payment, while pass-through devices get separate C-codes. Commercial contracts often pay implants at invoice cost plus a percentage, which only works if the invoice reaches the claim.
05
Benefits & Patient Estimates
High-deductible plans put a large share of ASC cases on the patient. Without an estimate and collection before surgery, the balance often goes uncollected.
06
Surgical Indication Gaps
Medicare's 2025 audit found that more than 70% of ASC improper payment dollars came from insufficient documentation. A missing H&P, order or indication is enough.
07
Bundling & Modifier Denials
ASC claims need modifiers that physician claims don't, such as 73 and 74 for procedures discontinued before or after anesthesia. Laterality and finger or toe modifiers are frequent denial triggers.
08
CMS Conditions for Coverage
Medicare-certified ASCs must meet the Conditions for Coverage in 42 CFR Part 416, and billing must follow the ASC Covered Procedures List for each year.
How Qualigenix Protects ASC Facility Revenue
Qualigenix assigns ASC-trained coders and billers to your center and runs each claim through the controls below.
Facility Charge Capture
We match every case on the OR schedule to a facility claim, so no completed case goes unbilled. Our charge capture accuracy is 98.5%.
Pre-Surgery Authorizations
We confirm the authorization covers the procedure, site and implant before the case date.
Contract & Fee Schedule Audits
We load your payer contracts and Medicare ASC rates, sequence procedures correctly, and flag any payment below the contracted amount.
Implant Invoice Matching
We attach implant invoices to the claim for carve-out payers and report pass-through C-codes for Medicare.
Benefit Verification & Estimates
We verify benefits and give your front desk a patient estimate before the case.
Chart-to-Claim Review
We check that the H&P, consent, operative report and implant log support each claim before it goes out.
Denial & Underpayment Appeals
We appeal denials and short payments with the contract terms cited. Qualigenix overturns 79% of denials across its client base.
Compliance Monitoring
We update edits each year when CMS publishes the ASC Covered Procedures List and payment rates.
CASE STUDY 01
How a 3-provider podiatry group cleared $214K in aged A/R
THE SITUATION
A 3-provider podiatry group with roughly 60% Medicare payer mix carried $412,000 in A/R, 38% of it past 120 days. Routine foot care claims (11720, 11721, 11055–11057) had stalled on inconsistent Q7/Q8/Q9 modifiers and class-finding documentation, so payers held or partially paid and nobody worked the remainder. Medicare crossover to secondaries was not being posted, and small patient balances were written off.
WHAT QUALIGENIX DID
We ran a full A/R aging segmentation, worked claims by payer and denial reason rather than by date, rebilled the stalled routine-care claims with corrected modifiers, and reactivated secondary and crossover billing.
Key Outcomes & Turnaround
38% to 14%A/R past 120 days
$214,000recovered from aged A/R
90 daysto turn it around
~60%Medicare payer mix
Audited Practice Results
How a solo podiatrist lifted first-pass acceptance to 96%
THE SITUATION
A solo podiatrist coding 320 encounters a month was stuck at 82% first-pass acceptance. Routine foot care went out without the systemic-condition diagnosis pairing and class findings Medicare requires, so it read as non-covered. Wound debridement was coded to the wrong depth (11042 for skin and subcutaneous where the note supported 11043 for muscle and fascia). Same-day E/M with a procedure went out without modifier 25 and got bundled.
WHAT QUALIGENIX DID
We rebuilt the coding workflow: diagnosis-to-CPT pairing rules for at-risk foot care, correct Q-modifier logic, depth-based debridement coding tied to the operative note, and disciplined use of modifiers 25 and 59/XS.
Key Outcomes & Turnaround
82% to 96%first-pass acceptance
+11%per-encounter reimbursement
60 daysto turn it around
320/moencounters coded
Audited Practice Results
How a 2-location podiatry practice cut its denial rate by two-thirds
THE SITUATION
A 2-location podiatry practice sat at a 19% denial rate, mostly Medicare routine-foot-care and nail-debridement rejections. The denials clustered in three buckets: medical-necessity rejections on routine foot care (missing qualifying diagnosis and class findings), frequency-edit denials on nail debridement billed inside the 60-day window, and missing Q modifiers that flagged services as non-covered.
WHAT QUALIGENIX DID
We built a front-end denial-prevention layer, checking eligibility and coverage against payer LCDs before claims went out, plus a structured appeal workflow with documentation templates mapped to each denial reason.
Key Outcomes & Turnaround
19% to 6%denial rate
$68,000recovered on appealed claims
4 monthsto turn it around
2 locationspractice size
Audited Practice Results
ASC Coding Across Every Specialty in Your ORs
Qualigenix codes facility claims across the specialties ASCs perform most.
Ophthalmology (66982, 66984)
Complex and standard cataract extraction with intraocular lens.
COMPLIANCE
How We Keep ASC Billing Compliant
Qualigenix keeps ASC billing compliant by billing only procedures on the current Medicare ASC Covered Procedures List, applying payment indicators and multiple-procedure discounting as CMS publishes them, and confirming that each case record meets the documentation standards behind the Conditions for Coverage in 42 CFR Part 416. Underbilling implants or discounted procedures leaves contracted money unpaid. Overbilling packaged items draws audits and recoupment. We hold a 98.6% compliance and audit pass rate with an over- and undercoding rate under 2%. All work is HIPAA compliant, with patient data handled under strict security controls.
Every case on the OR schedule gets a claim, and every line on that claim is backed by the chart.
0%
Audit Pass Rate
<0%
Variance Threshold
Why Qualigenix
0%
IMPROPER PAYMENT RATE
0%
FROM DOC GAPS
0%
FROM CODING ERRORS
$0M+
PAID IN ERROR
QUESTIONS BUYERS ASK
Qualigenix quotes each surgery center after reviewing case volume, specialty mix and payer contracts. Most centers start with a free ASC billing audit.
For Medicare, most implants are packaged into the procedure payment, and pass-through devices are billed with C-codes. For commercial contracts with implant carve-outs, we attach the invoice and bill at the contracted rate.
We use modifier 73 when a procedure is stopped before anesthesia is given and modifier 74 when it's stopped after. The operative note must show the reason.
Yes. We work aged ASC claims by dollar value and filing deadline. Across our clients, Qualigenix has cut days in A/R from 54 to 36.
Medicare pays each procedure on the ASC Covered Procedures List at its published ASC rate, based on its payment indicator. When more than one discountable procedure is done, the highest-paid one is paid in full and the others at 50%.
Yes. Qualigenix loads your contracted rates and flags every payment below the expected amount for appeal.
Yes. Qualigenix works in 133 EMR/EHR and practice management platforms and bills from your existing system.
Qualigenix onboards new clients in 6 days on average, including payer setup and contract loading.