Top Challenges in ASC Billing Services and How to Overcome Them in 2025

In Ambulatory Surgery Centers (ASCs), getting paid accurately and on time is more challenging than ever. With changing CMS rules, strict payer policies, and increasing administrative burdens, many ASCs are struggling to maintain a streamlined billing process. In this situation, using ASC billing services like Transcure can make the difference between profit and loss. In this post we’ll explore the top challenges in ASC billing in 2025 and provide practical tips to overcome each one. 

Top Challenges & How to Overcome Them

Below are major challenge areas for ASC billing in 2025, along with actionable tips to address them.

1. Changing Reimbursement Rates & Payment Policies

CMS has introduced new conversion factors, updated HCPCS/CPT codes, adjustments in drug/device payments (especially non-opioid drugs/devices), and stricter quality reporting requirements. If you don’t follow these rules, you might underbill or get denied. 

Tip: Maintain a process or team to monitor quarterly update notices from CMS and major payers. Use tools or software that auto-import CPT/HCPCS/ASC Addenda updates. Also, conduct monthly reviews to ensure your fee schedules and coding tables are in accordance with the current rules.

2. Prior Authorization & Insurance Verification Delays

More payers are tightening requirements; without valid prior authorization or full verification, claims are denied or delayed. This drags out Accounts Receivable (AR) days and hurts cash flow.

Tip: Build prior authorization checks into the scheduling workflow so that when a procedure is booked, the staff immediately verifies benefits, identifies required authorizations/referrals, and obtains them. Use eligibility-verification software or payer portals, and re-check eligibility on the day of surgery.

3. Claim Denials, Appeals & Denial Management Gaps

Even clean claims are often denied on first pass due to incorrect modifiers, missing paperwork or documentation, or policy changes. If there's no strong process for appeals, you lose revenue.

Tip: Have a dedicated denial management team or role. Track denial reason trends, send feedback to coders and schedulers, and appeal aggressively when denials are improper. Most importantly, use claim-scrubbing tools or perform audits to help catch repeated errors.

4. Compliance & Documentation Standards / Regulatory Risk

In 2025, new rules bring stricter scrutiny of documentation, including medical necessity, device and drug packaging, and the ASC-covered procedures list. Any compliance failures may result in recoupments, audit penalties, or reduced payment updates.

Tip: Invest in ongoing coder and clinical staff training. Make sure operative reports, supply logs, implant logs are thorough. Use EHRs or systems that use templates to capture required information. Plus, conduct periodic internal audits of randomly selected charts to ensure compliance.

5. Bundled Payments, Value-based Care & New Payer Models

As more players move toward bundled payments and value-based arrangements, ASCs must adapt their billing to account for shared savings, episode-based payments, and performance metrics. Mismanaging these models can lead to underpayment or disputes over revenue distribution.

 

Tip: Establish a financial analysis process for each bundled contract. Track costs and outcomes per episode to understand profit margins. Collaborate with physicians on quality metrics, patient satisfaction, and efficiency benchmarks, since these directly affect reimbursement. Use analytics tools to reconcile payments against expected bundle rates.

6. Limited In-House Resources & Rising Administrative Burden
   Managing ASC billing requires constant monitoring of payer updates, denial trends, compliance standards, and reporting requirements. Many centers struggle because their staff is already stretched thin with clinical and operational duties. This often leads to coding errors, delayed claims, and revenue leakage.

Tip: Outsource ASC billing services to a specialized partner like Transcure. Experienced billing companies stay updated on CMS and payer rules, handle denials systematically, and ensure claims are processed quickly. Outsourcing reduces administrative workload for your team while improving accuracy, compliance, and collections.

Conclusion

ASC billing in 2025 is complex, with challenges ranging from changing payer rules to increasing compliance demands. By staying updated, improving verification, managing denials, and outsourcing where needed, ASCs can protect revenue and streamline operations. The right billing strategies ensure not only timely payments but also long-term financial stability in an evolving healthcare landscape.