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The Administrative Burdens Hindering ASC Growth

Writer's picture: Emily SpoonerEmily Spooner

Updated: Nov 26, 2024



As the Ambulatory Surgery Center (ASC) market is projected to experience significant growth over the coming years, many ASC leaders and healthcare providers find themselves overwhelmed by administrative burdens that can slow progress and hinder operational efficiency. The following challenges—prior authorization, claims denials, and reimbursement issues—are a key part of this administrative strain, significantly affecting the ability of ASCs to deliver timely and effective care.


Prior Authorization Delays


One of the most significant hurdles for ASCs is the burden of prior authorization, a process that requires healthcare providers to seek approval from insurers before performing certain procedures. This process often delays patient care and increases administrative work, both of which can negatively impact the patient experience and the operational efficiency of ASCs.

Many healthcare providers report that the time spent managing prior authorization requests and handling denials contributes to delays in care and creates a disconnect between physicians and patients. The lack of transparency in the authorization process, combined with the complexity of requirements, results in frustration for providers, who feel that the process is designed more to limit care than to ensure appropriate coverage. As a result, ASCs and their staff are spending valuable time navigating these administrative hurdles rather than focusing on patient care.


Rising Claims Denials


Alongside prior authorization delays, claims denials are becoming an increasingly common issue for ASCs. As insurers continue to tighten their criteria for claims approval, healthcare professionals are spending more time managing denials, which often stem from incomplete or inaccurate patient data, authorization issues, or billing errors.


The lack of clear channels for addressing claims denials exacerbates the problem, leaving providers with limited options for recourse. Many physicians report having little opportunity to engage with payers directly, and even when they do, the process can feel like an uphill battle. As denials increase, ASCs are burdened not only by the administrative work of handling each claim but also by the uncertainty around whether their services will be reimbursed fairly and promptly.


Reimbursement Challenges


ASCs are also facing growing financial pressures due to reimbursement cuts and changes in payer policies. For example, recent changes to Medicare’s physician payment rule, which introduced a 2.83% cut for 2025, have drawn criticism from healthcare providers and advocacy groups. As costs for running surgical centers continue to rise, these reimbursement reductions make it harder for ASCs to maintain profitability and continue offering high-quality care.


In particular, surgical specialties and services like anesthesia and gastroenterology have been heavily impacted by reimbursement cuts. Many ASCs are finding it increasingly difficult to acquire new equipment, retain skilled staff, or expand their services while facing financial constraints from reduced reimbursements. The added strain from lower reimbursement rates often forces ASCs to make difficult choices, potentially compromising patient care or operational efficiency.


The Cumulative Impact on ASCs


These administrative challenges—prior authorization delays, rising claims denials, and reimbursement cuts—create a significant barrier to the growth and success of ASCs. In addition to the direct financial impact, these issues contribute to burnout among staff and frustration among physicians, ultimately affecting the quality of care that patients receive.


For ASCs to thrive in a competitive healthcare environment, addressing these administrative burdens is essential. Streamlining processes, improving transparency in insurance requirements, and advocating for more equitable reimbursement policies will help alleviate the administrative strain on providers, allowing them to focus on what matters most: delivering high-quality care to patients.


At Marisa Consulting, we understand the complexities facing ASCs and healthcare providers. Our expertise in operational efficiency, compliance, and strategic growth can help you navigate these challenges and optimize your practice for long-term success. Reach out today to learn how we can support your ASC in overcoming administrative hurdles and achieving sustainable growth. Call us now at 402-216-5226 for more information.

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