ASC billing services are the facility coding, claim submission, denial recovery and payment reconciliation that get an ambulatory surgery center paid its full facility fee. Nevada Medical Billing provides them for surgery centers in Las Vegas, Henderson, Reno and statewide, with a 98% first-pass clean claim rate across Medicare, Nevada Medicaid and commercial payers.
Full facility fees, fewer denials and no guesswork on Nevada payer rules. We match payment indicators, device credits and modifiers to every operative note, so your center gets paid right the first time.
A 30-minute review of your last 90 days of facility claims. No contract, no data migration, no obligation.
A Nevada ASC can run a full surgical schedule and still close the month short. The cases happened. The claims went out. The money stalled somewhere between the operative note and the remittance advice. These are the six leaks we find in almost every ASC revenue audit.
Under the Medicare ASC Payment System, supplies, most drugs and many ancillaries carry payment indicator N1 and fold into the procedure payment. Bill them separately and the payer denies them now or recoups them later. Miss the separately payable items, such as K2 drugs or qualifying device lines, and the center absorbs the cost.
Modifier 73 pays 50% of the facility rate; modifier 74 pays 100%. Swap them and you either lose half a case or invite an audit. Laterality, distinct-procedure modifiers and device credit modifiers carry the same weight on a facility claim.
Medicare expects ASC facility claims on the CMS-1500 (837P) with place of service 24. Some commercial contracts require the UB-04 (837I) with revenue codes. Nevada Medicaid pays Provider Type 46 claims by ASC level. One payer matrix error rejects an entire batch.
Out-of-network surgical claims sit in pending status for months while the payer reprices, requests records or issues a single-case offer far below billed charges. Without a documented appeal strategy, those dollars age into write-offs.
The surgeon adds a procedure in the room, and the authorization on file no longer covers the CPT code billed. For Nevada Medicaid members, the request also has to reach the right entity: the managed care organization or the fee-for-service QIO-like vendor.
One or two billers handle posting, follow-up, appeals and patient calls. The 90-day bucket grows quietly, and timely filing limits close before anyone works the oldest claims.
See exactly where your center is losing money. Request your free ASC revenue audit.
Nevada Medical Billing runs the full ASC revenue cycle or the specific stages your team wants off its plate. Every service below is built for facility billing, not adapted from physician office workflows.
An ASC case produces at least three claims: the facility fee, the surgeon's professional fee and the anesthesia claim. When those claims carry different CPT codes, diagnoses or laterality for the same date of service, payers flag the case and hold all of them. We reconcile facility and professional coding before submission, so every claim tells the same clinical story. For physician-owned ASCs, we can bill both sides under one team and one reporting view.
Our certified coders read the operative note, not the scheduling ticket. They assign CPT and HCPCS Level II codes, link ICD-10-CM diagnoses that prove medical necessity and confirm each code's ASC payment indicator (A2, G2, J8, P3, N1, K2) before the claim moves forward. Multiple procedures are sequenced so the highest-weighted procedure pays at 100% and each additional one at 50%, exactly as the ASC Payment System intends.
When implant cost reaches 30% or more of the procedure rate, CMS treats the case as device-intensive. We reconcile the implant log, the invoice and the operative note on every orthopedic, spine and neuromodulation case, report the correct C-codes, and enforce implant carve-outs in your commercial contracts.
We verify coverage, deductibles, coinsurance and out-of-network benefits at least 72 hours before surgery, then secure authorization for every planned CPT code. When the procedure changes in the room, we update the authorization or open a retro request the same day.
Every claim passes NCCI procedure-to-procedure edits, medically unlikely edits, payer-specific rules and Nevada Medicaid ASC level checks before it leaves. Claims go out within 48 hours of coding through your clearinghouse, in the form each payer requires.
We sort every denial by root cause (packaging, modifier, authorization, medical necessity, eligibility) and fix the upstream process, not just the claim. Appeals are built around operative note excerpts and payer policy. We also audit every payment against your contracted rates and the CMS ASC fee schedule, because a short payment that nobody flags is a denial nobody sees.
For out-of-network cases, we verify benefits up front, document usual and customary charges and push repricing offers through structured negotiation and appeal. For in-network contracts, we model reimbursement under percent-of-Medicare, percent-of-charges and case-rate terms, and flag chargemaster levels that leave money on the table.
Patients receive a clear estimate before surgery, including good faith estimates for uninsured and self-pay patients under the No Surprises Act. We collect deposits at check-in, send plain-language statements and offer payment plans, so patient balances stop aging past 60 days.
We enroll your ASC with Medicare, Nevada Medicaid, its managed care plans and commercial payers, and keep revalidation dates on a tracked calendar so no claim denies for an expired enrollment.
| Modifier | When we apply it | What it protects |
|---|---|---|
| 50, RT, LT | Bilateral and unilateral procedures | Correct bilateral pricing and laterality matching |
| 59, XE, XS, XP, XU | Distinct procedures that would otherwise bundle under NCCI | Separate payment the documentation supports |
| 73 / 74 | Cases discontinued before or after anesthesia | 50% versus 100% facility payment |
| FB / FC | Devices received free or with full or partial credit | Accurate device offset on device-intensive cases |
| PT / 33 | Screening colonoscopy that becomes diagnostic or therapeutic | Waived cost sharing and correct GI payment |
| SG | Commercial payers that still require it (Medicare retired it) | Payer-specific acceptance |
Each specialty brings its own codes, devices and payer edits. Our coders work by specialty, so the person coding your cataract cases is not learning on them.
Knee and shoulder arthroscopy (29881, 29827), total joints (27447, 27130) and spine cases moving into the ASC as CMS phases out the Inpatient-Only list. We capture implants, manage high-dollar authorizations and appeal denials on device-heavy claims.
Colonoscopy and EGD (45378, 45380, 45385, 43239) with correct screening, surveillance and diagnostic coding, modifier PT or 33 when screening becomes therapeutic, and pathology linkage that supports medical necessity.
Cataract surgery (66984, 66982), cataract with micro-invasive glaucoma devices (66989, 66991), laterality on staged bilateral cases and compliant patient billing for presbyopia-correcting and astigmatism-correcting lenses (V2788, V2787).
Epidural and facet injections (62321, 62323, 64483, 64490 to 64495), radiofrequency ablation (64633 to 64636) and spinal cord stimulator trials and implants (63650, 63685) with C-code device reporting and frequency limits tracked per payer.
ENT, urology, podiatry, plastic and reconstructive surgery, general surgery and dental cases under one roof, with specialty-specific edits and one consolidated report for the administrator.
Ownership, payer mix and case volume change how an ASC should be billed. We set up workflows, reporting and contract monitoring around the way your center actually operates.
Deep coding expertise in one specialty, payer edits tuned to your highest-volume CPT codes and benchmarks that compare your reimbursement per case with similar centers.
Specialty-trained coders assigned by service line, one consolidated A/R view and reporting by surgeon, specialty and payer, so the administrator sees which rooms and cases drive margin.
Facility and professional billing coordinated under one team, distribution-ready financial reporting for partners and clear visibility into each owner's case revenue.
Billing that follows joint venture reporting requirements, separates facility revenue cleanly from the hospital's outpatient department and supports both partners' audit needs.
Standardized charge capture, coding rules and denial workflows across every location, with site-by-site and group-wide dashboards.
Opening an ASC in Nevada? We handle Medicare enrollment through the CMS-855B, Nevada Medicaid Provider Type 46 enrollment, commercial payer credentialing, fee schedule setup and chargemaster build before your first case. Your center starts billing on day one instead of waiting months for enrollments to clear.
National billing companies treat Nevada like any other state. We do not. Nevada payers, Nevada Medicaid policy and Nevada licensure rules shape how we code, authorize and submit.
Nevada Medicaid reimburses freestanding ASCs (Provider Type 46) only for procedures assigned an ASC level on the DHCFP ASC Payment Groups and Procedures list, at an all-inclusive rate per level. We check the ASC level before scheduling, submit prior authorization through form FA-6 when required, and route requests and claims to the correct managed care plan or to the fee-for-service program. We also handle the exceptions that trip up out-of-state billers: sterilization consent forms, ordering provider NPI enrollment, prior authorization for skin substitutes (Q4101, Q4133, Q4186) and the all-inclusive implant rate for cochlear, BAHA, VNS and baclofen pump cases.
Nevada licenses ASCs as surgical centers for ambulatory patients under NRS Chapter 449, overseen by the Division of Public and Behavioral Health. We align billing documentation with those rules, CMS Conditions for Coverage and the standards AAAHC and The Joint Commission surveyors review.
CMS updates ASC rates, payment indicators and the covered procedures list every January. The CY 2027 proposed rule calls for a 2.4% update and 618 new ASC-eligible procedures, and centers that miss ASC Quality Reporting lose 2 percentage points of that update. We load each final rule into your edits before January 1 and confirm your ASCQR submissions stay on schedule.
We sign a Business Associate Agreement before we touch a chart. Access is role-based, encrypted in transit and at rest and logged for audit, and PHI never leaves controlled systems.
Every payer has its own claim form, edits, authorization rules and appeal windows. Our payer matrix covers the plans Nevada surgery centers bill most.
Medicare Part B facility claims processed by Noridian, the Medicare Administrative Contractor for Jurisdiction F, plus Medicare Advantage plans with their own prior authorization and medical necessity requirements.
Fee-for-service claims through the QIO-like vendor and claims to each Nevada Medicaid managed care organization, with ASC level checks and FA-6 prior authorization built into scheduling.
Anthem Blue Cross Blue Shield, UnitedHealthcare and Health Plan of Nevada, Aetna, Cigna, Humana, Hometown Health and Prominence Health Plan, each with its own contract rates, carve-outs and claim form requirements.
Nevada workers' compensation claims, personal injury and lien-based cases, TRICARE West and VA Community Care, each tracked separately because their documentation and payment timelines differ from standard insurance.
We support ambulatory surgery centers in every part of the state, from high-volume Las Vegas centers to single-specialty facilities in Northern and rural Nevada.
Las Vegas, Henderson, Summerlin, North Las Vegas, Spring Valley, Enterprise, Boulder City and Mesquite. Clark County holds most of the state's surgery centers and its most competitive commercial payer contracts, so we focus on contract monitoring, out-of-network recovery and high-volume claim throughput.
Reno, Sparks, Carson City, Minden and Gardnerville. Northern Nevada centers often serve patients who are covered by regional health plans and Medicare Advantage, so authorization management and payer-specific edits carry extra weight.
Elko, Fallon, Pahrump, Winnemucca and surrounding communities. Our remote billing model gives rural surgery centers the same specialty coding and reporting that large urban centers get, without adding staff on site.
Wherever your center operates in Nevada, your free ASC revenue audit starts with one call: (631) 652-3106.
We work inside the systems your center already uses. No new software to buy, no forced migration and no downtime on the surgical schedule.
SIS (Surgical Information Systems), HST Pathways, Amkai, AdvantX, Epic and other ASC platforms. Our team uses your charge capture, case costing and implant logs directly.
Waystar, Availity, Trizetto and payer portals, configured with a payer-by-payer submission matrix for 837P and 837I claims and electronic remittance (835) posting.
Your administrator sees clean claim rate, first-pass yield, days in A/R, denial rate by payer and reason, net collection rate and reimbursement per case, by surgeon and specialty. Weekly summaries and a monthly review call keep the board and physician owners informed.
We analyze 90 days of claims, denials and remittances and show you where revenue is leaking.
You choose full-cycle billing or targeted services. We sign the BAA and set up role-based system access.
We build your payer matrix, contract rates, ASC levels and edit rules.
Our team works alongside your staff for the first two weeks, so nothing falls through the handoff.
Aged A/R is worked by value and timely filing deadline, oldest high-dollar claims first.
Monthly KPI reviews, quarterly payer trend analysis and a yearly update at every CMS final rule.
| Factor | In-house billing team | Nevada Medical Billing |
|---|---|---|
| ASC-certified coders | Hard to hire and retain in Nevada | Specialty coders assigned to your center |
| Coverage during turnover and leave | Claims stall | Backup coders already trained on your account |
| CMS and Nevada Medicaid updates | Learned after denials arrive | Loaded into edits before effective dates |
| Underpayment auditing | Rarely done | Every remittance checked against contract |
| Cost structure | Salaries, benefits, software, training | One fee tied to collections |
Compare your current numbers with ours. Book your free ASC revenue audit.
You pay for results, not seats. We price each engagement around your case volume, specialty mix and implant intensity, and we quote only after we review your actual claims.
The most common model for ASCs. Our fee is a percentage of net facility collections, so we earn more only when your center collects more. Across the industry, outsourced ASC billing typically falls between 3% and 9% of net collections.
Best for high-volume centers with a stable case mix and predictable contract rates. One fixed fee per surgical case makes budgeting simple.
Keep billing in-house and outsource only what you need: facility coding, denial management, A/R cleanup, credentialing or out-of-network recovery.
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Get an exact quote with your free ASC revenue audit.
What Nevada ASCs see in the first 90 days: In days 1 to 30, the payer matrix and claim edits go live and aged A/R is ranked by dollar value and filing deadline. In days 31 to 60, the denial rate drops as root causes are fixed upstream. By day 90, the clean claim rate holds at 95% or higher and underpayments are recovered from contracted payers.
Can't find what you need? Our Nevada team answers every question before you commit.
ASC billing services cover the facility side of an ambulatory surgery center's revenue cycle: eligibility and authorization, facility coding, claim submission, payment posting, denial management, A/R follow-up and patient collections. The facility fee pays for the operating room, nursing, supplies and recovery, separate from the surgeon's professional fee.
The facility fee pays the surgery center for its resources and is billed by the ASC. The professional fee pays the surgeon and anesthesia provider for their services and is billed on their own claims. Both must agree on procedure, diagnosis and laterality to avoid denials.
Medicare ASC facility claims go on the CMS-1500 (837P) with place of service 24. Some commercial payers require the UB-04 (837I) by contract. We maintain a submission matrix for every payer your center bills.
No. Medicare retired modifier SG for ASC facility claims, but a few commercial and Medicaid plans still request it. We apply it only where a payer requires it.
Nevada Medicaid pays Provider Type 46 ASCs an all-inclusive rate based on the ASC level assigned to each surgical code. Procedures without an ASC level are not paid in the ASC setting, and some require prior authorization on form FA-6.
Most ASC billing companies charge a percentage of net collections, with the rate set by case volume, specialty mix and implant intensity. We quote after the free audit, based on your actual claims.
Yes. We prioritize aged claims by dollar value and timely filing deadline, then work them alongside current claims so new revenue does not slow down.
No. We work inside SIS, HST Pathways, Amkai, AdvantX, Epic and most other ASC systems through secure, role-based access.
Yes. We support ASCs in Las Vegas, Henderson, Summerlin, North Las Vegas, Reno, Sparks, Carson City and rural Nevada.
Reviewed by the Nevada Medical Billing ASC Coding Team (CPC and COC certified coders). Last updated October 2026.
Your surgeons already did the work. Let us make sure your center gets paid for it. In 30 minutes, we will show you your true clean claim rate, the denials costing you the most and the underpayments hiding in your remittances.
HIPAA compliant · No obligation · Response within one business day · Prefer to talk? Call (631) 652-3106