Surgical Center Medical Billing Services human-led, AI-accelerated
Surgical centers run on precision: clinical precision, scheduling precision — and billing precision. At Sirius Solutions Global we combine deep ASC billing experience with AI-powered automation so you get clean claims, fewer denials, faster payments, and defensible documentation. We handle facility billing, coordinate professional claims, manage device/implant coding, and work payer-specific issues so your teams can focus on patient care and the OR schedule.
Services we provide
1. Facility claim submission & clearinghouse management
-
Clean claim creation for facility charges, correct HCPCS/CPT selection, and clearinghouse submission with real-time rejection handling.
-
EDI/837 optimizations and payer enrollment/EDI troubleshooting.
2. Implant/device & C-code management
-
Accurate device reporting (C-codes/TPT), invoice-to-claim reconciliation, and manufacturer cross-walks so device costs are reimbursed properly.
3. Split-billing coordination (facility vs. professional)
-
Map which charges belong to the ASC (facility) and which to the professional provider. Coordinate with surgeons’ offices to ensure timely professional claim submission and avoid duplicative denials.
4. Prior authorization & medical necessity support
-
Identify procedures needing authorizations, prepare payer-ready clinical packets, and follow through to approval — reducing day-of-surgery cancellations and revenue risk. (Prior auth and eligibility are leading denial drivers.)
5. Charge capture & operative report reconciliation
-
Ensure every billable supply, implant, and service recorded in the OR appears on the claim. Use OCR and templated workflows to extract chargeable items from operative reports.
6. Denial management & appeals
-
Root-cause analysis (payer, CPT, provider, or system error), prioritized appeals for high-dollar claims, and a playbook for common ASC denial reasons.
7. Coding & modifier expertise
-
CPT/HCPCS/ICD-10 coding review with special attention to commonly missed or misapplied modifiers in ASC billing (TC/26, global periods, bilateral modifiers).
8. Payment posting & reconciliation
-
Daily remittance processing, patient responsibility posting, and variance reconciliation so AR reflects what’s actually collectible.
9. Analytics & continuous improvement
-
Procedure-level profitability, denial heatmaps (by payer/CPT/provider), and a continuous tuning program for AI scrub rules and coder training.
What makes ASC billing different
Ambulatory Surgical Centers bill the facility (ASC) component of procedures, often using a subset of ASC-approved HCPCS/CPT codes and specific payment group rules — while the physician or surgeon frequently bills the professional (PT) component separately. That split, along with device/supply reporting and payer-specific rules, makes ASCs uniquely sensitive to coding, modifier, and prior-authorization issues. Ensuring the correct facility vs. professional charge and the right modifiers (e.g., technical vs. professional components) avoids costly denials and underpayments.
Outcomes you can expect
After onboarding with practices like yours we typically focus on delivering:
-
Higher first-pass acceptance rates and fewer rejections at the clearinghouse.
-
Faster payment cycles and lower Days in AR.
-
Fewer day-of-surgery cancellations due to missing prior authorizations.
-
Recovery of missed device and supply charges through targeted appeals.
We quantify baseline and post-engagement metrics so ROI is visible and trackable.
Common surgical center denial causes
-
Incorrect patient demographics / insurance — catch at scheduling & verify pre-op.
-
Missing or expired prior authorizations — proactive ident and submission.
-
Coding and modifier errors (including missing TC/26) — coder review + AI flags.
-
Device/supply misreporting — invoice-to-claim reconciliation and C-code handling.
How our AI helps
We use purpose-built automation that surfaces exceptions and accelerates routine work — humans make the final, defensible decisions:
-
Automated claim scrubbing finds missing tooth/implant references, incorrect dates, or mismatched payer IDs before submission.
-
Predictive denial scoring prioritizes at-risk claims for human review so appeals and pre-submissions focus on high-impact cases.
-
OCR and intelligent extraction pull chargeable items from operative notes and device invoices, cutting manual entry and missed charges.
-
Smart rules for device codes help flag TPT/cost-based device line items and ensure proper documentation is attached.
why surgical centers choose us
-
ASC expertise: Facility-focused billing workflows, device/C-code handling, and HCPCS/CPT mapping that understands the OR. (See CMS ASC payment guidance.)
-
AI-assisted claim quality: Automated scrubbing, predictive-denial flags, OCR for operative reports, and exception routing to experienced billers.
-
Denial prevention & recovery: Root-cause analysis and appeals workflows that target high-dollar denials (patient data errors, auths, modifiers).
-
Device & supply expertise: Implant and supply coding (C-codes / TPT device rules), charge capture, and manufacturer billing coordination.
-
Transparent reporting: KPI dashboards for Days in AR, denial trends, net collection rate, and procedure-level profitability.
How We Increase Your ASC Earnings
Surgical center billing at Sirius Solutions Global takes a proactive and end-to-end approach. We arrange your practice for success as follows:
Frontend Accuracy: Before any procedures are set, we start with thorough eligibility checks and permissions.
Certified coders go through every operative report to guarantee all billable elements are included.
Our billing specialists customize every claim according to the payer's instructions, therefore guaranteeing great acceptance rates.
Denial Prevention and Appeals: Every valid claim is appealed as we follow and evaluate denials and then apply tactics to prevent problems going ahead.
Monthly Financial Reporting: Get total visibility with monthly performance reports, bespoke analytics, and insights to help to increase revenue trends.
Faster Reimbursements
Our knowledgeable billing team makes sure clean claims are submitted quickly, therefore cutting processing times and accelerating payments from both patients and payers. We use automation tools and payer-specific invoicing methods to remove delays so that your income flows more quickly.
Lower Denial Rates
Having insurance experts and certified surgical coders on board helps us to reduce coding errors, eligibility problems, and missing paperwork—the main causes of claim denials. To greatly raise your approval rates, our proactive strategy includes prebill audits and real-time denial management.
Improved Compliance & Audit-Readiness
To guard your surgical facility from legal liability and penalties, we uphold complete HIPAA compliance and adhere to CMS and payer-specific rules. Your records and coding are always audit-ready and in line with the most recent industry standards thanks to our internal QA inspections and billing audits.
Real-Time Reporting & Transparency
Our customized reporting dashboards will let you always see how your billing is doing. With complete openness and practical insights, monitor KPIs, including claim aging, rejection justifications, monthly income, and reimbursement rates.
Increased Revenue with Less Overhead
Outsourcing your billing to us frees you from the expensive requirement for internal billing employees, software licenses, and continuous training. We help you capture every dollar you make, cut revenue leakage, and raise your profit margins—without raising operational expenses.
Support for All EHR/PM Platforms
Whatever other system you use—Athenahealth, Kareo, AdvancedMD, eClinicalWorks—our staff matches perfectly with your current EHR/PM configuration. No retraining, no interruption. We change to your workflow and assist you in maximizing your technical capabilities.
Common Challenges Surgical Centers Face in Medical Billing
Surgical centers have particular billing demands that are very different from those of hospitals and physician offices. Denials, compliance concerns, and lost income can result if these demands are not properly satisfied. Here are the most often encountered difficulties ASCs deal with:
Complex Case Coding
Many operations include several operations, surgeons, assistants, and modifiers. Avoiding undercoding or overcoding, both of which can cause denials or audits, demands great knowledge in coding them correctly.
Insurance Regulations Variable behavior
Every payer has rules of its own. Some package services; others do not. For particular operations, some need preauthorization. Tracking these subtleties without professional help is time-consuming and prone to mistakes.
Narrow Reimbursement Margins
ASCs often operate on tighter margins than hospitals. Any payment delays or denials might have a major impact on their financial health. This clarifies why timely follow-up and accurate claim submission are so important.
Errors in Documentation
Surgeons and staff might concentrate on patient care rather than records, which would cause missed or erroneous data entries. For best reimbursement, we make sure every note, code, and modifier follows payer guidelines.