In-Network vs. Out-of-Network Billing in ASCs: How Finnastra Navigates Both

Ambulatory Surgery Centers (ASCs) operate in a complex reimbursement landscape where payer relationships play a critical role in financial success. Whether billing in-network or out-of-network, each pathway comes with its own challenges, risks, and revenue opportunities.

Navigating these complexities requires precision, strategy, and a deep understanding of payer contracts and regulatory rules. As a leading Ambulatory Billing Company, Finnastra ensures your ASC maximizes reimbursements while staying compliant and audit-ready.

This article explores the key differences between in-network and out-of-network billing for ASCs, common pitfalls, and how Finnastra’s expertise helps surgery centers thrive in both models.

Understanding In-Network vs. Out-of-Network Billing

In-Network Billing

When an ASC is in-network, it has a contractual agreement with a payer to provide services at pre-negotiated rates.
Benefits:

• Predictable reimbursement rates.
• Faster claim approvals and fewer disputes.
• Greater patient volume due to payer referrals.

Challenges:

• Lower reimbursement rates than out-of-network billing.
• Rigid compliance requirements.
• Negotiation challenges when contracts are outdated or unfavorable.

Out-of-Network Billing

ASCs may also treat patients with insurance plans for which they are not contracted, which is considered out-of-network billing.
Benefits:

• Higher reimbursement potential on certain procedures.
• Greater flexibility in pricing.

Challenges:

• Higher denial rates and delayed payments.
• Patients may face unexpected balance bills, creating dissatisfaction.
• Payers may deploy aggressive cost-containment tactics.

Industry Data: According to MGMA, out-of-network claim denials are 2.5x higher than in-network claims, and resolution can take up to 30% longer without proper follow-up processes.

The Strategic Role of Finnastra in Payer Management

1. Contract Negotiation for In-Network Success

For in-network ASCs, financial performance is heavily influenced by payer contracts. Unfortunately, many centers accept outdated agreements without realizing how much revenue they are losing.

Our Ambulatory Billing Services are designed to simplify the contract management process by:

• Benchmarking current reimbursement rates against industry standards.
• Negotiating better terms for high-volume procedures.
• Ensuring language in contracts protects your ASC from unexpected write-offs.

Case Study: A multi-specialty ASC in Texas increased its annual revenue by 18% after Finnastra renegotiated its top three payer contracts.

2. Mastering Out-of-Network Billing

While out-of-network billing can offer higher margins, it requires careful navigation to avoid compliance pitfalls and revenue leakage.
Finnastra provides a comprehensive out-of-network strategy, including:

• Accurate and compliant charge capture to prevent payer disputes.
• Upfront patient financial counselling to improve transparency and minimize surprise billing concerns.
• Appeals and negotiation tactics to secure maximum reimbursement while reducing delays.
• Guidance on when transitioning to in-network status may be financially advantageous.

Result: A California-based ASC specializing in orthopedic surgeries reduced its out-of-network claim denial rate by 42% within three months of partnering with Finnastra.

3. Advanced AR Follow-Up

Regardless of network status, AR follow-up is critical to maintaining cash flow.

• In-network claims require swift processing to meet payer deadlines.
• Out-of-network claims need persistent, informed appeals to overcome payer pushback.

When you work with a dedicated Ambulatory Billing Company like Finnastra, you gain access to specialized AR teams trained to handle both claim types efficiently.

Key Compliance Considerations

Regulatory compliance is paramount in both billing models.

• Surprise Billing Laws: The federal No Surprises Act has strict guidelines for balance billing in out-of-network scenarios.
• State-Level Variations: Some states have additional payer-specific rules affecting reimbursement and patient communication.
• Documentation Standards: Proper documentation is essential to defend claims during audits.

Finnastra integrates compliance-first workflows into every step of the billing process, reducing your ASC’s exposure to legal and financial risks.

Questions ASC Leaders Should Ask

• Are our payer contracts aligned with current market rates?
• How much revenue are we leaving on the table due to poor negotiation or underpayments?
• Do we have clear processes to handle out-of-network patients compliantly?
• Are our AR days above 40, indicating cash flow challenges?

If these questions raise concerns, it may be time to evaluate your billing strategy.

Why ASCs Choose Finnastra

As a leading ASC Billing Company, Finnastra delivers a tailored approach to help your surgery center succeed with both in-network and out-of-network billing. Our services include:

• Comprehensive payer contract review and negotiation.
• Transparent patient responsibility estimates to improve satisfaction.
• Dedicated denial management to prevent revenue leakage.
• Free PM/EHR software to streamline operations.
• Credentialing and enrollment support at no cost to your ASC.

We don’t just process claims—we build long-term financial stability for your organization.

Maximize Your ASC’s Reimbursement Potential

The decision between in-network and out-of-network billing isn’t one-size-fits-all. It requires a nuanced strategy built on deep payer knowledge, data-driven insights, and relentless follow-up.

With Finnastra as your partner, you gain the expertise needed to optimize both billing pathways, improve cash flow, and protect your ASC from compliance risks.

Get Started Today

Discover how Finnastra’s Ambulatory Billing Services can help your ASC navigate complex payer landscapes and unlock higher revenue potential.

Visit our Ambulatory Surgery Center Billing Services page or schedule a consultation today to take control of your ASC’s financial future.