Common culprits include missing ASC-specific modifiers (SG, -59), coding a non-covered CPT, or submitting the wrong place of service (24). Finnastra’s pre-bill scrub applies more than 1,200 ASC edits and achieves a 96 % first-pass rate, slashing denials before they leave your clearinghouse.
Medicare pays 100 % of the highest-valued procedure but automatically discounts subsequent procedures, often by 50 %. If codes are sequenced incorrectly, ASCs can lose 10-25 % per case. Finnastra’s claims engine orders CPTs correctly and checks bundling rules to capture every allowable dollar.
SG identifies the claim as the facility component of an ASC service; omitting it usually triggers an instant rejection. Finnastra appends SG (and any secondary modifiers) automatically, ensuring compliance with Medicare, Medicaid, and commercial payer requirements.
Device-intensive procedures require separate HCPCS lines and, in many states, attached invoices. Finnastra maintains a live implant-cost file, attaches invoices electronically, and checks each claim against the latest CMS device-intensive list to prevent underpayments.
Incomplete op notes, missing implant logs, or absent anaesthesia grids are top triggers for “information requested” denials. Finnastra’s ASC documentation checklist verifies every chart and uploads required docs with the initial claim, cutting document requests dramatically.
CMS updates the ASC Covered Procedures List, wage indexes, and device-intensive thresholds annually. Finnastra’s regulatory tracker feeds nightly rule updates into our clearinghouse and flags any new coverage or coding changes for your team.
Up-front estimates, point-of-service payments, and digital payment plans raise self-pay collections by 25 % or more. Finnastra’s patient portal delivers real-time estimates, card-on-file options, and automated reminders to accelerate cash.
Focus on
Finnastra’s dashboard streams these metrics daily and sends variance alerts so you can intervene
early.
Yes. We offer API and HL7 interfaces for leading ASC systems such as HST, NextGen, SIS, and
Modernizing Medicine, enabling automated charge capture, eligibility checks, and real-time payment
posting without disrupting your workflow.
Every payer has its quirks, frequency limits, carve-outs, implant caps. Finnastra maintains a payer
rule library that updates daily; our rules engine validates each claim against the correct plan policy
before submission, cutting rework and appeals.
