Case volumes are up. The rooms are full. The schedule is packed.
And yet, margins are shrinking.
That is the story heading into the 2026 ASCA Conference. Growth is real. But four cost pressures are hitting at the same time:
- Anesthesia stipends, now affecting 44% of ASCs
- Supply chain inflation, compounded by new import tariffs
- CMS reimbursement falling below inflation
- Prior authorization delays holding cash 45 to 75 days
Many ASC billing teams are not built to absorb all four challenges at the same time.
If your facility collects between $1 million and $5 million per month, even small billing inefficiencies can translate into significant monthly revenue leakage. The problem is often not external pressure alone, it is what happens inside your revenue cycle when those pressures hit. High denial rates, slow days-in-AR, missed charges, and undetected payer underpayments are the silent signs that your current RCM setup is not keeping up. This article shows where those gaps live and connects each one to a fix.
The Core Problem: Volume Is Up, But the Math Is Not Working
ASC case volumes are projected to grow 9% between 2023 and 2028. Strong, steady growth.
But here is the issue.
CMS updated ASC reimbursement by just 2.6% in 2026. The market basket, the real measure of healthcare cost inflation, is 3.3%. That means the reimbursement update does not even cover inflation.
Then add four more pressures on top of that. Each one is manageable individually, but all four at once? That is what is squeezing margins right now.
Is Your RCM Setup Keeping Up? Four Signs It Isn't
External pressures are real. But many ASCs have another problem. Their billing systems are not built to handle all four pressures at the same time.
Here are signs your revenue cycle management software may be struggling:
- Your denial rate is above 5%. A strong ASC usually keeps its clean claim rate above 95%. If more claims are denied, your staff spends more time fixing problems and waiting for payment.
- Your days in AR is above 35. Most healthy ASCs get paid within 30 to 35 days. Once AR goes above 40 days, cash flow slows down. Above 50 days is a major warning sign.
- You find missed charges after the case is closed. If implants, devices, or supplies are billed days later, your charge capture process has gaps. Even a few missed charges can cost thousands of dollars over time.
- You cannot easily spot payer underpayments. Many ASCs do not have tools that compare payments against contract rates. As a result, underpayments often go unnoticed and revenue gets lost quietly.
If these problems sound familiar, the four pressures below are not just outside challenges. They are making existing billing gaps even worse.
Pressure 1: Anesthesia Stipends, A Fixed Cost That Keeps Growing
Data from 2025 showed that 28% of ASCs provided anesthesia stipends. In 2026, that number jumped to 44% (VMG Health, 2026).
This is a big shift. A stipend is a fixed cost. It does not go up or down with your case volume. You pay it whether you run 80 cases a week or 120.
So the only way to get more value from that fixed cost is to run more cases. That means better scheduling. It means tighter block use. It minimizes unused time in the OR.
CERTIFY Health’s patient-scheduling software helps ASCs manage block time and case scheduling more efficiently. When rooms stay full and cases start on time, you get more out of every dollar in fixed overhead.
Pressure 2: Supply Chain Inflation, Plus Tariffs Nobody Budgeted For
Medical supply costs were already set to rise 2.41% in 2026.
Then came tariffs. New import tariffs of 10–54% hit orthopedic implants, surgical tools, and medical devices. For an orthopedic or spine ASC, implants are one of the biggest cost lines in the budget. A 20–30% jump in implant cost changes the math on those cases fast.
You cannot bill your way out of a tariff. But you can ensure every implant is captured correctly and billed the same day it is used.
That is where strong billing operations matter. CERTIFY Health’s practice management software supports same-day charge capture. Every implant, every device, every supply item gets logged and submitted right away. No week-long delays. No missed charges. No revenue left on the table because of a manual process.
Pressure 3: CMS Reimbursement Below Inflation, Every Year, the Gap Gets Wider
A 2.6% update against a 3.3% market basket sounds like a small difference.
But it compounds. Every year the gap widens. Every year it costs more to run an ASC than Medicare pays to perform the same cases.
This is where the quality of your revenue cycle management software starts to matter a lot. When reimbursement is already tight, every denied claim hurts more. Every late submission costs more. Every payer underpayment that goes unnoticed adds up.
ASCs with efficient billing operations, high first-pass claim accuracy, rapid denial resolution, and consistent payer contract monitoring recover revenue that many facilities miss.
Pressure 4: PA Delays Can Hold Cash for 45 to 75 Days
This one is the most damaging pressure in 2026.
Prior authorization activity continues to rise in ASCs. When a claim goes into prepayment review, payment is delayed 45 to 75 days. Even when the case is paid in full, you wait two months for money that should have arrived in 30 days.
That is a direct hit to cash flow. And it hurts EBITDA even when you eventually get paid.
But here is what most ASCs miss: the problem starts before the claim is filed. A common cause of PA denials is failing to secure authorization before the procedure is performed. The patient comes in. The surgery happens. Then someone discovers the PA was missing or wrong.
At that point, it is too late to fix it quickly.
The right fix is upstream. CERTIFY Health’s revenue cycle management software builds PA verification into the pre-case workflow. Authorization is confirmed days before the patient arrives, not the morning of surgery. Fewer surprises. Fewer delays. Faster cash. CERTIFY Pay also helps practices capture downstream collections more efficiently by streamlining patient payment workflows after care is delivered.
For orthopedic, spine, and cardiology cases, where PA requirements are highest, this one change can move the needle on days in AR.
Where the Billing Gap Lives: A Clear Summary
Here is the picture when you put all four pressures together. Each one creates a specific gap. Each gap has a specific fix.
| Pressure | Gap | Fix |
|---|---|---|
| Anesthesia stipends rise to 44% of ASCs | Fixed cost that does not scale with volume | Tighter scheduling and block use |
| Supply costs up 2.41% plus tariffs on implants | Per-case margins shrink | Same-day charge capture so nothing gets missed |
| CMS reimbursement 2.6% against 3.3% inflation | Every claim matters more | Clean claims, fast denials, payer variance tracking |
| PA delays — 45 to 75 days of cash lost | Cash flow slows even when cases are paid | Pre-case PA verification built into scheduling |
None of these gaps fix themselves. And none of them get better with more volume alone.
How CERTIFY Pay and CERTIFY Health Help Protect ASC Margins
CERTIFY Pay is built for the revenue integrity challenges ASCs face right now.
It handles PA verification before cases go on the schedule. It supports real-time charge capture so implants and devices are billed the same day. It runs clean claim checks before submission to cut first-pass denials. And it flags payer underpayments against your contracted rates automatically, so contract leakage stops building up quietly.
For ASCs focused on patient payments, CERTIFY Pay offers text-to-pay, multi-channel payment, and digital billing and collection tools. Patients get clear, simple payment requests. Your team spends less time chasing balances by phone.
This is what good revenue cycle management software actually does. It does not just process claims. It closes the gaps that shrink margins.
CERTIFY Health covers the front end of that same workflow.
It supports scheduling and block use, so your fixed anesthesia costs generate maximum throughput. It also handles patient intake, including financial eligibility checks and benefit verification. Patients know their financial responsibility before surgery day.
That reduces billing surprises, improves collections, and helps patients prepare financially.
The Financial Picture Heading Into ASCA 2026
ASC growth is real. The 9% volume projection is solid. The shift from hospital to ASC settings is not slowing down.
But volume alone does not protect margins. Not when four cost pressures are building up at the same time. Not when reimbursement is already below inflation.
The ASCs that will hold, or grow, their margins are the ones with a strong revenue cycle management setup. Clean claims. Fast PA verification. Daily charge capture. Payer variance detection.
The question is simple: do you know where your gap lives?
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