5 Ways to Measure Your ASC Billing Process
Modern data enable ASCs to make fine-tuned adjustments that build an efficient workforce. Yet, practices routinely fail to identify critical areas that need review. Far-sighted providers will spend significant time researching how to best gauge invoicing proficiency.
Here are five ways to measure the effectiveness of your ASC billing process.
Adopt Key Performance Indicators
Key performance indicators (KPIs) are measurable standards that an ASC should track over time. Failing to set and observe appropriate KPIs will obscure a practice’s performance.
Here are some of the most critical billing standards:
● Clean Claims Percentage: A high clean claims percentage indicates billing precision. Review industry data to determine what claim acceptance rate is acceptable for your practice.
● Annual Changes: Comparing quarters across years gives practices a broad overview of their financial performance.
● Long-Lasting A/R: Experts suggest keeping the percentage of A/R over 90 days below 15%. If your practice exceeds this threshold, your billers may have prioritization problems.
● Days Sales Outstanding (DOS): DOS is the average number of days spent in A/R. High DOS implies your team is behind on patient engagement.
● Days to Bill: Billing delays often translate to inflated DOS, time-sensitive denials, and write-offs.
● Days to Pay: Knowing which insurers take the longest to pay creates an invaluable chart. Slow payers may need contract adjustments or specialized invoicing procedures.
● Write-Off Percentage: Write-offs frequently occur because of failures to follow basic regulations. Excessive write-offs should make practices redesign their billing structure.
Track Scheduling Failures
An efficient ASC should avoid gaps where facilities or workers are idle. Unfortunately, scheduling failures often leave staff unengaged, even during busy quarters. This lag can lead to billing teams having little work one week, then too much the next.
Make notes each time scheduling failures slow workflow. Review this record at the end of the month. This process will reveal how much avoidable downtime your practice accrues monthly.
Audit Payer Contract Knowledge
A lack of denials does not guarantee that billers are securing maximum returns from payers. Insurers will never press practices for the privilege of paying more. So, providers must audit billers to determine how well they understand contracts.
Gauge staff’s contract familiarity by monitoring when they request additional details. Waiting until submission deadlines before seeking necessary documents indicates poor payer understanding.
Review Provider Communication Breakdowns
Many errors occur because of communication breakdowns between providers and invoicing staff. Internal audits should review physician notes to ensure they supply billers with necessary, clear information. Digital records simplify communication standardization and note inspections.
Hire a Professional Billing Service
Measuring in-house billing effectiveness requires significant time and energy. To eliminate this burden, professional invoicing companies deliver regular reports that detail their performance. These statements show claims, timelines, and amounts secured. So, providers have all the information necessary to determine whether billers satisfy their standards.
Plutus Health maintains clinical records and provides regular reports outlining our work. This precision has consistently earned us high returns and numerous accounts. As a result, our certified ASC coders have solidified their skills, fortifying practices’ income. Connect with us, so we can walk you through our financing options.
Key Takeaways
1. Regularly track key performance indicators.
2. Mark scheduling failures as disruptions to your billing workflow.
3. Audit insurance contract knowledge.
4. Review communication between providers and invoicing staff.
5. Professional billing services routinely report their performance.
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FAQs


ABA providers are grappling with high staff turnover (up to 65%), rising burnout, administrative overload, and stagnant reimbursement rates. These challenges directly impact care continuity, clinical outcomes, and operational performance.


Operational inefficiency costs ABA teams up to 10 hours per staff member per week, contributing to burnout, denied claims, and longer accounts receivable (A/R) cycles. These inefficiencies ultimately result in reduced revenue and patient dissatisfaction.


Burnout leads to costly turnover, lower client retention, and decreased productivity. Recruiting and replacing a BCBA or RBT can cost up to $5,000 per hire, plus months of lost revenue and disruption to morale.


High-performing ABA organizations invest in clear career pathways for BCBAs and RBTs, align compensation with market benchmarks, and foster peer-led mentorship, flexible schedules, and wellness programs.


Automation tools like Plutus Health's Zeus streamline eligibility verification, denial management, and billing, reducing manual workloads by 5–10 hours weekly per clinician and improving clean claim rates by 95%.


Outsourcing revenue cycle management can improve collections, reduce denials by up to 30%, and free clinicians from billing-related admin tasks, resulting in better client care and financial outcomes.


One $200 million ABA network partnered with Plutus Health to automate eligibility and accounts receivable (A/R) processes. The result: $2M reduction in legacy A/R and a 97% Net Collection Rate.


By improving operational efficiency, investing in technology, and ensuring workforce stability, ABA leaders can align outcomes with reimbursement. Plutus Health supports this transition with scalable RCM and automation strategies.
FAQs


ABA therapy billing is the process of submitting claims to insurance or Medicaid for Applied Behavior Analysis services provided to individuals with autism or developmental disorders. It includes using correct CPT codes, proper documentation, and adherence to payer-specific policies.


Common CPT codes for ABA therapy in 2025 include:
- 97151 – Assessment and treatment planning
- 97153 – Direct therapy with the patient
- 97155 – Supervision and modification of behavior plan
- 97156 – Family adaptive training
- Always check with payers for any annual changes.


To bill Medicaid for ABA services, providers must ensure credentialing is complete, services are pre-authorized, and claims use the correct codes and modifiers. Medicaid requirements vary by state, so always follow state-specific billing rules.


Common ABA billing mistakes include:
- Incorrect or missing CPT codesplan
- Lack of documentation or treatment
- Uncredentialed providers rendering services
- Submitting duplicate or late claims


Without proper credentialing, providers can’t get reimbursed. Insurance and Medicaid require that BCBAs, RBTs, and organizations are credentialed and contracted. Delays in credentialing often cause revenue losses and claim rejections.
FAQs


CMS proposes a 2.4% increase in Medicare ASC payment rates, contingent on meeting ASCQR quality reporting requirements. Plutus Health helps ASCs meet these compliance benchmarks by integrating quality reporting data into RCM workflows, ensuring eligibility for full payment updates.


The ASC Covered Procedures List will expand by 547 procedures, including cardiology, spine, and vascular surgeries. Plutus Health supports expansion into new service lines by customizing RCM processes for high-acuity procedures, minimizing claim denials during the transition.


Site-neutrality narrows the payment gap with hospital outpatient departments, enhancing ASCs' cost-efficiency appeal. Plutus Health helps leverage this advantage in payer negotiations by providing performance dashboards and cost-justification analytics to secure stronger reimbursement terms.


Complex procedures increase denial risk and slow cash flow. Plutus Health's automation-first RCM model delivers 95%+ clean claim rates, reduces A/R days, and safeguards margins, even as your case mix becomes more complex.