Is the 16-Day RPM Rule No Longer a Revenue Barrier for OBGYNs?

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The 16-day RPM rule is becoming less of a revenue barrier for OBGYNs due to regulatory clarifications, improved device compliance, and better billing workflows. Previously, the requirement that remote patient monitoring (RPM) devices collect data for at least 16 days per 30-day period limited reimbursement opportunities. For OBGYN practices managing pregnancy-related monitoring and chronic maternal conditions, this rule often restricted consistent RPM reimbursement . Recent operational adjustments and clearer CMS guidance are changing how practices approach RPM billing for OBGYNs . What Is the 16-Day RPM Rule? The 16-day RPM rule requires that patient monitoring devices record and transmit data for at least 16 days within 30 days to qualify for monthly RPM reimbursement. This rule was designed to ensure consistent patient engagement, but it created challenges in: Short-term pregnancy monitoring Intermittent blood pressure tracking Gestational diabetes management Post...
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Maximizing ASC Margins in an Era of Shifting Site-of-Service

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Maximizing ASC Margins in an Era of Shifting Site-of-Service

The ambulatory surgery center (ASC) landscape is changing rapidly. As payers continue shifting procedures away from hospitals and into lower-cost outpatient settings, ASCs are seeing higher surgical volumes—but not always higher profits. Rising implant costs, tighter reimbursement models, and complex billing rules are placing increasing pressure on ASC margins.

In today’s environment, ASC revenue success is no longer driven by volume alone. It depends on how well facilities manage billing complexity, facility fee optimization, and implant revenue recovery. Without a focused billing strategy, even high-performing ASCs risk leaving significant revenue uncollected.

ASC Billing Is No Longer Simple

ASC billing has evolved far beyond basic claim submission. Facilities now handle a growing mix of high-acuity procedures, payer-specific billing requirements, and detailed compliance standards. Each case involves multiple revenue components, including professional fees, facility fees, implants, supplies, and modifiers.

Many ASCs struggle because their billing processes were built for lower complexity procedures. As surgical case mix expands, outdated billing workflows fail to capture the full value of services provided.

The Impact of Shifting Site-of-Service Trends

Payers are increasingly directing surgeries to ASCs due to lower costs and improved efficiency. While this shift creates growth opportunities, it also introduces new challenges:

  • Higher-cost implants with limited reimbursement windows

  • Increased scrutiny of facility fee billing

  • More complex coding for advanced procedures

  • Greater audit and compliance risk

To stay profitable, ASCs must adapt their billing strategies to match this evolving site-of-service landscape.

Facility Fee Optimization: A Critical Revenue Lever

Facility fees represent a major portion of ASC revenue. However, they are often underbilled or incorrectly reported due to documentation gaps or coding errors.

Facility fee optimization requires:

  • Accurate procedure mapping

  • Proper revenue code selection

  • Alignment with payer-specific ASC payment rules

  • Complete operative documentation

When facility fees are not optimized, ASCs may receive partial payments or experience avoidable denials that directly reduce margins.

Implant Revenue Recovery: A Hidden Opportunity

Implants are one of the largest cost drivers in ASC operations. Unfortunately, implant-related revenue is also one of the most commonly missed or underpaid components of ASC billing.

Common implant billing challenges include:

  • Incomplete charge capture

  • Missing device documentation

  • Incorrect HCPCS coding

  • Payer reimbursement limitations

Effective implant revenue recovery ensures that every eligible device is billed accurately and supported with proper documentation. This alone can significantly improve ASC financial performance.

High-Acuity Surgical Coding for Multi-OR Facilities

As ASCs expand into more complex procedures, coding accuracy becomes even more critical. High-acuity surgical cases require advanced knowledge of CPT guidelines, modifier usage, and payer policies.

Multi-OR facilities face additional challenges, including:

  • Concurrent procedures

  • Assistant surgeon billing

  • Multiple procedure discounts

  • Modifier sequencing errors

Without specialized coding expertise, these cases often result in underpayments or compliance risks.

Why Specialized ASC Billing Services Matter

General medical billing services are not designed to handle the complexity of modern ASC operations. Specialized ASC billing services focus specifically on the financial and regulatory realities of ambulatory surgery centers.

MBC provides dedicated ASC billing services built to support:

  • Facility fee optimization

  • Implant cost recovery

  • High-acuity surgical coding

  • End-to-end revenue cycle management

This focused approach helps ASCs protect margins while maintaining full compliance with CMS and commercial payer requirements.

How MBC Helps ASCs Maximize Margins

MBC works closely with ASC leadership to identify revenue gaps and implement targeted billing improvements. Their services are designed to reduce administrative burden while improving cash flow and reimbursement accuracy.

Key areas of support include:

  • Accurate coding and charge capture

  • Clean claim submission and denial prevention

  • Timely appeals and underpayment recovery

  • Compliance with ASC payment rules

  • Actionable financial reporting

By aligning billing workflows with operational realities, MBC helps ASCs turn complexity into a competitive advantage.

Billing Smarter in a High-Pressure Environment

ASC success today requires more than efficiency in the operating room. Financial sustainability depends on smart billing strategies that adapt to payer changes, surgical complexity, and rising costs.

Facilities that invest in specialized ASC billing services are better positioned to:

  • Recover lost revenue

  • Improve reimbursement consistency

  • Reduce audit exposure

  • Scale operations confidently

In an era of shifting site-of-service, billing excellence is no longer optional—it is essential.

Conclusion

Maximizing ASC margins in today’s healthcare environment requires a deep understanding of billing complexity, facility fee optimization, and implant revenue recovery. As procedures continue moving from hospitals to ASCs, the ability to bill accurately and compliantly becomes a critical differentiator.

With specialized ambulatory surgery center billing services from MBC, facilities can protect profitability, reduce operational strain, and focus on delivering high-quality surgical care. In a complex reimbursement landscape, the right billing strategy makes all the difference.

Location: United States

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