Revenue lift · Ambulatory surgery center
Revenue lift · Ambulatory surgery centerImplant carve-out recovery added $1.7M in year-one collections.
A 6-OR orthopedic and spine ASC in Tampa was systematically underbilling implant carve-outs against payer policy. Medonix rebuilt the implant invoice tracking workflow and recovered $1.7M in year-one collections that had been written off as contractual adjustments.
- Ambulatory surgery center · Orthopedics & spine
- Client: 6-OR ambulatory surgery center
- State: FL
- Revenue lift
Outcome at a glance
Before and after, on the metrics that mattered.
Implant recovery, year 1
Denial rate
Days in A/R
The situation
Where the practice was when Medonix engaged.
A 6-OR orthopedic and spine ASC in Tampa had been operating with a generalist billing vendor that lacked ASC-specific playbook depth. Implant carve-outs (procedures where the implant cost is reimbursed separately from the facility fee) were not being tracked or billed against payer policy, and the dollar value was being silently absorbed as contractual adjustment.
The ASC administrator suspected the practice was leaving money on the table on implants but had no way to quantify it. Their commercial-payer mix included three plans with explicit implant carve-out provisions in the contract, and they had no internal process to cross-check implant invoices against billed amounts.
A peer ASC administrator at an MGMA conference mentioned Medonix's ASC playbook depth, including implant carve-out workflows. The Tampa ASC engaged Medonix for a discovery audit.
The work
What Medonix actually did.
Discovery surfaced 18 months of historical implant cases where carve-out billing had been missed or underbilled. The aggregate value at risk for recovery was approximately $2.3M, with $1.7M still recoverable inside payer-specific timely-filing windows.
Medonix rebuilt the implant invoice tracking workflow with vendor-supplied invoices attached at the claim level, payer-specific carve-out rules built into the scrub engine, and a monthly reconciliation against ASC implant purchasing records to catch any missed cases going forward.
For ongoing operations, the ASC playbook covers multiple-procedure reductions, modifier 50 and 59 logic, ASC payment-group classification, and approved-procedure-list checking before claim submission.
The outcome
Where the practice landed.
Year-one implant carve-out recovery totaled $1.7M, recovered from claims that had been past-billed but never resubmitted with implant detail attached. The recovery process took six months of active appeals and resubmissions with documentation.
Going-forward implant billing accuracy reached 99.4% measured at the carve-out level, meaning effectively all eligible implant cases now bill at the correct carve-out amount the first time.
Denial rate dropped from 7.8% to 4.1% and days in A/R compressed from 38 to 22 over the same year. The ASC administrator presented the year-one results at the next MGMA conference as a reference case.
Want a reference like this one
Talk to a Medonix client in ambulatory surgery center.
Book a discovery call and we will arrange a reference call with a Medonix client whose specialty, payer mix, and industry profile matches yours. Twenty to thirty minutes, no Medonix on the line.
Related case studies
Read next.
- Revenue lift
PPS encounter capture lift produced $920K in additional grant-protected revenue.
A 3-site federally-qualified health center in rural North Carolina was leaving PPS encounter rate revenue on the table due to documentation and billing-cycle mismatches. Medonix rebuilt the encounter-capture workflow and recovered $920K in year-one revenue, plus established sustainable wraparound payment reconciliation.
3-site FQHC · NC
Read the full study - Denial reduction
Cath-lab denial rate from 11.2% to 3.4% in 90 days.
A 12-provider cardiology group in Houston was bleeding revenue on cath-lab denials and modifier 25 / 59 errors. Inside one quarter on Medonix, denial rate dropped to 3.4% and the appeal-overturn queue cleared an aged backlog worth roughly $480,000.
12-provider cardiology group · TX
Read the full study - Vendor switch
First month with Medonix collected 14% more than last month with prior vendor.
A 4-provider family medicine practice in Columbus moved off a regional billing vendor to Medonix using the parallel-run migration. The first full month under Medonix posted 14% more cash than the last month with the prior vendor, with the aged A/R workdown still in progress.
4-provider family practice · OH
Read the full study
Talk to RCM
Ready to recover every dollar your practice earns?
See your projected revenue lift in 60 seconds, or talk to a senior RCM strategist now. No commitment. Same-day slots available.
- 30-day parallel-run guarantee
- Targets written into the contract
- HIPAA · SOC 2 Type II · HITRUST