What We’re Watching
"If the surgeon books the surgery at the clinic site, your revenue cycle partner should start working that CPT code on the back end the minute it's scheduled, so you can anticipate any pushback."
This week the math changed for out-of-network billing. The No Surprises Act IDR overhaul takes effect August 3, and the new $15 administrative fee (down from $115) makes arbitration worth pursuing on a whole tier of lower-dollar claims that never penciled out before. The rule also forces payers to put standardized reason codes on out-of-network remittances, which means the signal for an IDR-eligible claim now shows up the day payment posts, not months later in an aging report. Bottom line: the dispute work that used to start after a denial now starts before one. Teams built to see it coming will pull ahead.
This Week's Reads
The articles published this week on exactrx.ai dig into what that means operationally, and what it looks like when payers get there first. This week we have two new articles, one on stopping denials before they start, one on building a center the right way.
Deals Tracker
What to Watch Next
CMS may pull surgery centers into episode-based payment. The TEAM bundled model launched January 1, mandatory for hospitals across 188 markets, and two of its five episodes can be triggered in an ASC designated as a hospital outpatient department, pushing volume outpatient.
Upcoming Events
A note for our Tennessee locals: We're based right here in Brentwood, so the TASCA calendar is close to home for us. The Fall Conference & Trade Show heads to the Hilton Knoxville on September 24–25. With over 160 licensed ASCs across the state, it's a good room to be in. If you're going to either, reply and let us know. We'd love to say hello in person.
"There's an incentive in the inpatient, outpatient combined episodes to shift more volume into outpatient surgery."
What are you seeing on the ground? Whether it is a denial pattern, a payer behavior, or a cost that keeps showing up in the wrong place, hit reply. We read everything.
This newsletter goes out to a focused group of operators, finance leaders, and revenue cycle professionals working in ambulatory and outpatient settings. If someone forwarded this to you and it felt relevant, it probably was.