Ambulatory Surgery Billing
Built for speed, accuracy, and defensible revenue
ASCs move fast. You run tight schedules, high-value supplies, and procedures that depend on precise coding and authorization. That’s why ASC billing must be both surgical and scalable: surgical in the sense of precise, specialist coding and defensible documentation; scalable in the sense that it must keep up with OR throughput without burdening staff. At Sirius, we design ASC billing workflows that stop denials, capture every billable supply, and streamline prior authorization all while keeping clinicians focused on care.
Our ASC Billing & RCM Services
1. Patient Registration and Eligibility Check
We check coverage, copayments, deductibles, and prior approval before the treatment to prevent claim rejects starting from day one.
2. Exact ICD-10 and HCPCS/CPT coding
Our certified coders make sure that every procedure—including modifiers—is coded to the highest level of detail to meet payer requirements.
3. Claim Submission and Charge Entry
We file claims online quickly to speed up turnaround and minimize payment delays. Charges start very quickly.
4. Appeals and refusal control
Our dedicated personnel carefully reviews and revises rejected claims and fiercely argues against underpaid claims.
5. Reconciliation of Payments and Posting
Payments are posted swiftly as a whole reconciliation procedure ensures every service is tracked.
6. Support for compliance and audits
For internal or outside audits, we gather detailed reports and follow strict HIPAA regulations.
7. Performance Analysis and Reporting
Real-time dashboards presenting financial performance indicators, refusal trends, and collection rates enhance decision-making.
Benefits of Choosing Sirius Solutions Global for ASC Billing
✅ Faster Payments: Optimized claims pay you in as little as 7 to 14 days.
✅ Reduced Denials: Our artificial intelligence marks coding or documentation faults before submission.
✅ Increasing Collections: We assist you in grabbing every dollar you have made.
✅ Better Compliance: Stay in line with HIPAA standards, payer policies, and CMS.
✅ Lower Overhead Expenses: No need to engage and train an in-house billing team.
✅ Scalable Solutions: We grow with you whether you operate one ASC or many.
Ambulatory Surgery Center (ASC) Billing, Simplified
ASC billing is the process of invoicing outpatient surgical operations using CPT and HCPCS codes and then filing claims for payment. Medicare pays ASCs the lesser of the actual cost or the ASC facility payment rate (established in CMS's yearly and quarterly fee schedule papers). The billing form varies according to the environment: hospital-affiliated ASCs use UB04, whereas freestanding ASCs use CMS1500.
Key Aspects of ASC Billing
Coding
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CPT codes: Recognize the surgical operations carried out.
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HCPCS codes include certain services as well as supplies captured (including pass-through devices and medications).
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Add detail; for bilateral procedures, for example, 50.
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Sometimes needed by private insurance companies. ICD-10 codes
Billing Forms
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CMS1500: For independent ASC billing of outpatient services.
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UB04: To fit with hospital billing for hospital-affiliated ASCs.
Payment Structure
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Medicare sets a predetermined payment for facility services, usually linked to a proportion of the hospital outpatient department rate.
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Beneficiaries typically pay 20% of the smaller of the charged amount or the ASC payment rate, depending on patient responsibility.
CMS Guidelines and Resources
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Annual and quarterly transmission updates keep the ASC Payment System current.
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Official hub for manuals, coding instructions, and price schedules: ASC Center on CMS.
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See Chapter 14 for ASC claims processing information in the Medicare Claims Processing Manual.
Payment Policies
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Some costs (e.g., the technical aspect of radiological guidance for injections) could be packaged inside the main operation.
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Reimbursement for bilateral and multiple surgeries adheres to ASC policy for modifier 50 (bilateral) and modifier 51 (multiple procedures).
How to Bill
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Pick the proper CPT and HCPCS codes for the services rendered.
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Choose the appropriate form—CMS1500 for independent ASCs or UB04 for hospital-affiliated ASCs.
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Submit the claim to the payer with all necessary codes and information, such as Medicare.
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Monitor remittances and payments to confirm reimbursement fits the ASC price schedule.
5 revenue-first actions we add to your center
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Pre-op Eligibility & Cost Estimates (Patient-First)
We verify benefits and provide a clear, empathetic cost estimate before the patient arrives. If coverage is uncertain, the team receives a one-click script to collect consent or payment. This reduces day-of cancellations and surprise balances. -
Prior Authorization Readiness (Policy-Aware)
We monitor payer lists and CMS demos that impact ASCs, start authorizations early, and prepare the exact clinical documents payers want — saving time and avoiding disruptive denials. -
CG Modifier & Claim Coordination (Precision Billing)
ASC reimbursements hinge on exact modifier and coding alignment between facility and physician claims. Our coders and scrubbers verify CG/G modifiers and prevent conflicting edits that lead to denials or underpayments. -
Supply & Implant Reconciliation (Stop the Leakage)
High-value implants and disposables are revenue drivers — and often missed. We reconcile OR supply logs to claims, ensuring every chargeable implant and supply is billed with supporting documentation. -
Fast Denial Triage with Appeals Playbooks (Recover Revenue Faster)
Denied claims are automatically triaged by reason and routed to the right specialist with an evidence-backed appeals template. High-value denials are escalated and tracked to resolution.
Why Partner with Sirius Solutions Global?
Our method combines: we work with your ASC to enhance financial stability rather than simply handle claims.
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Professional human coders with
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Cutting-edge artificial intelligence technologies predicting claim problems before submission
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Managers of committed accounts for individual support
Our mantra captures it all:
We rectify issues as well as keep them fixed; we do not only locate them.
Supervised AI & human governance
We pair automation with human judgment for safe, scalable billing:
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Human-in-the-loop: AI identifies issues and suggests actions; humans approve changes for any high-impact decisions.
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Real-time escalation: Negative sentiment or high-cost exceptions trigger live staff notification.
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QA & sampling: Regular transcript and claim audits scored for accuracy and compliance.
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Audit trail & BAA-ready logs: Secure logs with role-based access for compliance and dispute resolution.
This model speeds routine tasks while keeping your revenue and reputation defensible under audit.
Why Ambulatory Surgery Billing Requires Specialized Expertise
Unlike conventional hospital billing, ASC billing entails:
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Varied reimbursement rates: Medicare ASC payment groups vs. physician/hospital rates
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A large number of claims with quick turnaround
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Specialized CPT codes for surgical operations
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Multiple provider claims and bundled payment systems
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Requirements for prior authorization specific to payers
Every month, a typical billing system could cost your ASC thousands of dollars. Our crew therefore concentrates solely on ASC-specific processes to make sure no money is left on the table.
How Sirius Voice AI helps urgent care practices
Many ASCs operate alongside urgent care or partner with local walk-in clinics. Sirius Voice AI brings immediate operational lift to those workflows — and the same benefits help ASCs
Appointment smoothing
Voice confirmations reduce walk-in congestion and guarantee patient prep (fasting, consent) fewer day-of cancellations.
Eligibility & cost conversations
AI begins the verification and cost estimate conversation so staff can focus on exceptions.
POCT & supply notifications
For urgent care testing that dovetails with surgical pipelines, the AI ensures results and supplies are captured and linked to claims.
Sirius Voice AI
Positioning AI as the “first responder” in communications improves both patient experience and downstream ASC throughput.
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