Uncovering Hidden Revenue Options in Your ASC
ASC executives have reported concerns regarding growing business costs and relatively static reimbursements. CMS’s recent removal of covered procedures may be partially responsible for this discrepancy. This change has disrupted the monetary stability of many surgical centers.
While adaptable ASCs will maintain viable returns, stagnant providers may find their revenue disappearing. So, practices should invest resources into implementing long-lasting financial solutions.
Here are some revenue options hidden in your ASC.
AR Clean up
This will give way to find more money to review any outstanding A.R. Follow up on unpaid claims and further follow up on denied claims. This practice allows to re-bill any not received claims at insurance end and appealing denied claims for further re-imbursement.
Cross Trained Staff
Cross-training involves taking medical staff from one work sector and instructing them in another. This process achieves several key goals:
- Workers can fill in critical roles in case of absences.
- Colleagues grasp how poor communication hampers the ASC’s workflow.
- Employees can ask realistic, specific requests from other sectors.
- Staff learns the difficulties of different tasks and how to mitigate them on their end.
Automatic Notifications
Automatic notifications help reduce long-lasting accounts receivable. These systems identify high-risk consumers failing to pay and send them a reminder. Automating A/R management significantly reduces staff’s time and effort expenditure.
Additionally, advanced software sends repeat consumers reminders for upcoming appointments. This process reduces patient no-shows and late arrivals, increasing providers’ time efficiency.
Payment Data Analysis
Modern healthcare competition forces practices to invest in technologically generated data. Systems such as 360 analytics generate actionable statistics based on patient information. Providers can review these details to determine which invoicing approaches work best for individuals.
Point of Service Charges
Experts estimate that charging patients at the point of service (POS) nets 40% higher returns than waiting until they leave. Requesting payment upfront may frustrate some consumers. However, doing so eliminates several negatives attached to post POS invoicing:
- Patients skip the arduous, stressful period of being hounded for payment.
- Billers have extra time to secure maximum returns from insurers.
- Practices avoid portal transaction fees or physical mail costs.
Worker Specialization
Studies reveal that patients with high out-of-pocket costs generate poor returns. Consumers with over a $5,000 balance had collection rates four times lower than small accounts.
To avoid high balances, coders must consistently secure substantial payments from insurers. Specialization helps achieve this goal by maximizing the quality each worker can produce.
Practices should segment internal audits to focus on specific features. For example, auditors could review Medicaid code adherence one week, then switch to insurer deadline compliance the next. Concentrating on one area at a time helps reduce distracting ancillary details.
Plutus Health has mastered specialization and expertise in ASC Billing. Our talented team members excel at securing maximum returns from both patients and insurers. If building an elite billing workforce daunts you, we offer a financially efficient alternative. Connect with a representative for an in-depth look at your RCM prospects.
Key Takeaways
- Cross-training boosts staff communication between sectors.
- Software-driven notifications automatically target consumers who need reminders.
- Data analysis empowers providers to make strategic adjustments.
- Point-of-service charges increase returns and eliminate certain inefficiencies.
- Specialized coders and auditors reduce the billing errors and helps for accurate billing.
Liked the blog? Share it
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.