Ambulatory surgery centers (ASCs) play a vital role in delivering cost-efficient, specialized outpatient care. With thinner margins than hospitals, ASCs face heightened revenue and cash flow risk when denials or reimbursement delays occur—particularly with implant-and device heavy procedures in orthopedics, pain management, and ophthalmology, where complexity can create uncertainty and financial disruption if not carefully managed.
This is why an effective accounts receivable (AR) management process is critical. Drawing on decades of experience supporting ASCs nationwide, we’ve found three key strategies that consistently drive better results across specialties.
3 Strategies to Secure Every Dollar Earned
At nimble, with more than two decades of experience supporting ambulatory surgery centers across 45+ states, we’ve seen that effective accounts receivable (AR) management is the cornerstone of financial health. When AR is managed effectively, cash per case is maximized, cash flow is accelerated, and growth is achievable.
I. Master the Payer Contract Landscape
A common challenge for ASCs lies in accurately managing contracts within their systems. Without integrating contract terms and posting contractual adjustments at charge entry, AR reports can appear inflated, giving a false picture of collectible revenue. In addition, this can make both automating payment posting and detecting payer underpayments more difficult.
Applying contractual requirements at the time of charge entry is especially critical with implants, where payer rules often diverge between commercial contracts and Medicare guidelines. The complexity increases under Medicare Advantage plans: a patient’s card may display “Blue Cross Blue Shield,” but reimbursement will still follow Medicare rules, not the commercial contract. Without an expert team to review the requirements and ensure accurate charge posting on these implants, denials and payer underpayments are likely to occur. Many of the systems used today in ASCs have the capability to build contracts in the system to help with this process but many centers don’t have the team to do it accurately. Leveraging a partner to support this process can be critical.
II. Strengthen Front-End Processes and Preauthorization
In working with new ASCs, it is found that over 40% of denials are caused by the front-end. That underscores the need for robust front-end and pre-authorization processes in place.
Effective AR performance begins at the front end. Accurate demographic capture and payer verification set the stage for clean claims and realistic AR reporting. Relying on an insurance card does not suffice; the front-end teams of ASCs must confirm plan details directly with the payer to ensure benefits, networks, and authorization requirements are correctly applied from the start.
Authorizations are equally critical to maintaining AR accuracy. Missing or incorrect authorizations—whether tied to diagnosis codes, revenue codes, or ASC/professional details—don’t just trigger denials, they create inflated AR and mask true collectability. By having a front-end expert in authorizations as well as configuring systems to reflect payer-specific requirements,especially for implant-heavy procedures, ASCs can prevent these errors, reduce delays, and ensure authorizations are obtained before the procedure.
III. Ensure Compliance with Payer Policies and Coding Accuracy
Accurate AR depends on a deep understanding of billing rules, payer policies, and contract specifics.
- Payer Guidelines
ASCs need to understand and align their systems and processes with payer-specific guidelines. Some procedures require multiple codes, but not all codes are reimbursed; payers may bundle services, or certain modifiers may be required. Frequency limits, such as Medicare’s cap on specific injections, must be verified at the front end to prevent denials. Performing these checks before the procedure protects AR, reduces preventable denials, and accelerates reimbursement.
- Medical Necessity
Another critical priority is medical necessity. Reimbursement is contingent on procedures meeting payer-defined criteria, and claims lacking proper documentation are frequently downcoded or denied, creating delays in AR.
ASCs must accurately document and code each service to reflect what was performed and comply with payer guidelines and required treatment protocols. Adhering to medical necessity requirements reduces denials and safeguards revenue.
Driving AR Performance and Financial Stability for ASCs
Even with effective billing and clinical practices, ASCs can face denials and revenue disruptions tied to payer requirements. Drawing on unique and laser-focused experience in the ASC space, nimble works alongside our clients to recognize payer trends, anticipate denials, and apply strategies that help safeguard your revenue.
From implants in orthopedics and ophthalmology to procedural frequency limits, we ensure contracts are fully integrated into RCM workflows, claims are submitted accurately, and AR reflects true collectible revenue.
ASCs don’t just need claims paid—they need confidence that every case delivers its full financial value. By protecting revenue, reducing denials, and strengthening AR, centers can maximize cash per case and stay focused on what matters most: delivering outstanding patient care.
Want to see how nimble can strengthen your AR and protect your revenue?
