SpecialtiesSurgical
How we see asc billing.
Reviewed by the VisMed surgical billing team
An ambulatory surgery center bills for the room, the staff, the supplies and the implants, on a claim that uses procedure codes but is paid by facility rules: payer-specific groupers or fee schedules, multiple-procedure discounts, implant and device carve-outs, and the form the payer wants, which differs. A biller trained on physician claims will build ASC claims that are systematically short.
Implants are the sharpest example. Some payers pay them separately at invoice plus a margin, some include them in the procedure payment, and some require an invoice attached. A center that does not know each contract’s implant terms is either giving implants away or having claims rejected.
VisMed builds a contract matrix for each ASC during onboarding, holding each payer’s grouper, form, implant and multiple-procedure terms, and our facility coders build every claim from it. We reconcile the surgery log to the facility claims case by case and compare every payment with the contract.
Where asc practices lose money
The patterns we find in the aging and denial history before anything else changes.
Implants and devices
Billed without the payer’s required invoice, coded without the right revenue code, or not billed at all when the contract pays them separately.Multiple-procedure and grouper rules
Each payer discounts second and subsequent procedures by its own rules, and groupers map procedures to payment levels differently. Claims built without the contract terms are short or denied.Wrong claim form or payer requirements
Some payers want the institutional form, some the professional form with a facility modifier, and some have their own attachments. The wrong one is rejected.Cases unbilled or incomplete
A busy center without a log-to-claim reconciliation misses cases and misses lines within cases.Out-of-network payments
Out-of-network ASC claims are paid at payer-determined amounts and patient balances are constrained. Without a strategy and deadline tracking, the center accepts the first offer.
What we do differently for asc
Specialty-matched coders and a denials specialist, working inside your own system.
We build a contract matrix
Each payer’s grouper or fee schedule, claim form, implant terms, multiple-procedure rules and attachment requirements held in one place and applied at claim build.Our facility coders build the claims
Claims coded from the operative report for the facility side, with implants and supplies captured from the case record.We reconcile the log
Every case on the surgery log matched to a facility claim, and to the professional claim where applicable, with variances worked weekly.We review payment variances
Payments compared with the contract terms case by case, with underpayments appealed.
What we bill
The procedure and code families your account team already works in.
ASC billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
How does VisMed make sure implants are paid?
By knowing each contract’s implant terms and applying them at claim build: separate line with the right revenue code where paid separately, invoice attached where required, and included where the contract bundles them. VisMed then checks payments against the terms.
Does VisMed handle both the facility and the professional claims?
Yes, where the surgeons bill through VisMed as well. Either way, we reconcile the surgery log to every claim so cases are complete on both sides.
How does VisMed know each payer’s ASC rules?
VisMed builds a contract matrix during onboarding from your payer contracts and fee schedules, and maintains it as contracts change. Every claim is built from it, and every payment is compared with it.
What about out-of-network cases?
VisMed reviews payments against benchmarks, uses negotiation and dispute processes inside their deadlines where the numbers justify it, and applies patient responsibility rules correctly.
Does VisMed handle Medicare ASC enrollment and the quality reporting program?
VisMed’s credentialing team handles the enrollment, and our reporting team tracks the ASC quality measures through the year, because a missed submission reduces the following year’s Medicare payment rate on every case.
Also in surgical
General surgery
Global-period tracking and assistant-at-surgery claims.
Orthopedics
Fracture care, implants and DME.
Neurosurgery
Multi-level procedures and co-surgeon billing.
Vascular surgery
Office-based labs and imaging supervision.
Thoracic surgery
Complex globals and critical-care overlap.
Plastic surgery
Reconstructive vs cosmetic separation.
Oral & maxillofacial surgery
Medical and dental claims on one case.
ENT
In-office procedures, audiology and allergy.
Ophthalmology
Eye-code vs E/M choice, injections and ASC.
Urology
Lithotripsy, in-office procedures and pathology.
OB/GYN
Global obstetric packages and gyn procedures.
Anesthesia
Time units, modifiers and medical direction.
All specialties
The full list, in six groups
See where your asc practice is losing money. Free.
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