ASC Billing in Texas: Revenue Leaks from Denials & Downcoding in 2026 – 12 Critical Gaps Draining Your Surgical Revenue

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  Introduction: Why ASC Billing in Texas Is Under Pressure ASC billing in Texas: revenue leaks from denials & downcoding in 2026 is becoming a major concern for ambulatory surgery centers across the state. ASCs are experiencing rapid growth due to cost efficiency and patient preference for outpatient procedures. However, with this growth comes increased scrutiny from payers and more complex billing requirements. Texas has a diverse payer landscape that includes Medicare, Medicaid managed care, and multiple commercial insurers. Each payer applies unique reimbursement models, packaging rules, and documentation requirements. This complexity creates multiple points where revenue leakage can occur. Without strong ASC billing services and reliable medical billing services , even high-performing surgical centers can experience declining margins. Identifying and fixing these leaks is essential to maintaining profitability in 2026. Understanding Revenue Leaks in ASC Billing Revenue le...
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Basics of Medicare Consolidated Billing for SNFs

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Need for Consolidated Billing for SNFs

Prior to the Balanced Budget Act of 1997 (BBA), a Skilled Nursing Facility (SNF) could elect to furnish services to a resident in a covered Part A stay, either, directly using its own resources; through the SNF's transfer agreement hospital; or under arrangements with an independent therapist (for physical, occupational, and speech therapy services). In each of these circumstances, the SNF billed Medicare Part A for the services.

However, the SNF also had the further option of ‘unbundling’ a service altogether; that is, the SNF could permit an outside supplier to furnish the service directly to the resident, and the outside supplier would submit a bill to Medicare Part B, without any involvement of the SNF itself.

This practice created several problems, including the following:

  • Potential for duplicate (Parts A/B) billing if both the SNF and outside supplier billed;
  • An increased out-of-pocket liability incurred by the beneficiary for the Part B deductible and coinsurance even if only the supplier billed; and
  • A dispersal of responsibility for resident care among various outside suppliers adversely affected quality (coordination of care) and program integrity

Then Balanced Budget Act of 1997 (BBA), was enacted, containing a Consolidated Billing (CB) requirement for SNFs. Under the CB requirement, an SNF itself must submit all Medicare claims for the services that its residents receive. Conceptually, SNF CB resembles the bundling requirement for inpatient hospital services that's been in effect since the early 1980s, assigning to the facility itself the Medicare billing responsibility for virtually the entire package of services that a facility resident receives, except for certain services that are specifically excluded.

To get more information about Medicare Consolidated Billing for SNFs click here: https://bit.ly/3vmPAjQ. Get in touch with us at: info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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