Facility contracts without implant terms
An ASC contract that reimburses a flat case rate with no implant carve-out loses money on every device-heavy case.
Provider credentialing
Ambulatory Surgery Center Credentialing
An ASC needs Medicare certification as a facility, contracts with every payer for the facility fee, and a medical staff credentialing program for the surgeons and anesthesia providers who work there. We handle all three so the center is payable from its first case.
- CMS-855B plus certification survey
- Facility contracts with implant terms
- Surgeons privileged before first case
- Physician ownership disclosed
- Timeline: 6 to 12 months to Medicare approval
7-14 daysto onboard your practice end to end
Weeklystatus report on every open application
50 statesMedicare, Medicaid and commercial panels
Ambulatory surgery centers enroll with Medicare through a CMS-855B and must pass a certification survey against the ASC conditions for coverage, conducted by the state or an accrediting organization. Commercial payers contract for the facility fee separately from the surgeon's professional fee, and those contracts, often with implant carve-outs, decide whether the center is profitable. Inside the center, every surgeon and anesthesia provider must be credentialed and privileged by the ASC itself.
ClainetRCM manages ASC enrollment and certification, negotiates and loads facility contracts, and sets up or operates the medical staff credentialing program to accreditation standards.
Where this usually goes wrong
Surgeons not privileged before the first case
Accreditation and state rules require surgeons to be credentialed and privileged before operating. Centers that open with incomplete files face survey deficiencies.
Survey scheduling
Certification surveys must be scheduled and passed before Medicare pays. A center that is not survey-ready loses months.
What ClainetRCM handles for you
One coordinator owns every file from intake to effective date.
- State ASC licensure and Medicare certification survey preparation
- CMS-855B enrollment with ownership and physician investor disclosures
- Commercial, Medicare Advantage and Medicaid facility contracts with implant and multiple procedure terms reviewed
- Medical staff credentialing program setup for surgeons, anesthesia and allied providers
- Primary source verification, privilege delineation and reappointment for all medical staff
- Revalidation, accreditation renewal and change of ownership filings
ASC credentialing components
Medicare certification
CMS-855B plus survey against ASC conditions for coverage; accreditation by AAAHC, Joint Commission or similar accepted in lieu of state survey.
Facility contracts
Payer-specific case rates, grouper-based or percentage of charges, with implant and multiple procedure terms. See payer contracting.
Medical staff credentialing
Every surgeon and anesthesia provider credentialed and privileged by the ASC. See hospital privileging.
Physician investors
Ownership disclosed on the 855B and updated on changes.
Anesthesia
CRNAs and anesthesiologists credentialed at the center and enrolled with payers for professional billing.
How the work runs
- 1
Intake and gap review
Licenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
- 2
Profile setup
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- 3
Application submission
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- 4
Follow-up on a fixed cadence
Payers are contacted on a schedule. Requests for more information are answered the same business day.
- 5
Approval, contract and handoff
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
Frequently asked questions
From licensure to Medicare approval, typically six to twelve months, driven by survey scheduling and 855B processing. Accreditation surveys can sometimes be scheduled faster than state surveys.
Both. The ASC credentials and privileges each surgeon to operate there; payers credential each surgeon for professional fee billing separately. We handle both processes.
Case rates by procedure group, implant reimbursement or carve-out, multiple procedure rules, timely filing and appeal terms, and a defined product list. We model each contract against your expected case mix before signature.
Yes. We provide credentialing, privileging, verification and reappointment for ASCs that do not have dedicated medical staff staff, to the standard your accrediting organization requires. See primary source verification.
Free revenue audit
Find out what your practice is losing to denials.
Send us 90 days of remittance data and we will show you, line by line, which claims were underpaid, denied, or never worked, and what it would take to recover them. No cost, no obligation, and you keep the report either way.
No setup fee. No long-term contract. Pricing from 2.29% of monthly collections.