As surgical volume shifts to the outpatient setting, the ASCs that win treat reimbursement as strategy — not paperwork. Fulcrum Health Partners partners with surgery centers on commercial contracting, case-rate and carve-out strategy, analytics, and growth, turning payer complexity into durable enterprise value.
Payers want procedures in the ASC. The question is whether your rates keep pace with the cases.
With roughly 10,000 centers nationwide and total joints, spine, and cardiology now migrating to the outpatient setting, ASCs are the fastest-growing site of surgical care. Yet Medicare still pays an ASC only about half of the hospital outpatient rate for the same procedure — and commercial results hinge entirely on how the contract is structured.
Case rates, implant and device carve-outs, multiple-procedure reductions, and out-of-network exposure under the No Surprises Act determine whether a case is profitable or a loss. That is precisely where Fulcrum works.
Figures reflect recent national industry data and estimates (CMS, MedPAC, industry sources), 2024–2026.
ASCs deliver the same procedure at a fraction of the hospital cost — the value case payers reward, if the contract is built for it.
Fulcrum turns your case and claims data into executive dashboards. Select an ASC profile to explore a sample payer-mix and case-economics view.
Illustrative sample dashboard. Fulcrum builds these from your ASC billing and practice-management data across every service line.
Not a service menu — the reimbursement problems that decide ASC profitability, and the contracting, analytics, and negotiation capabilities that resolve them.
Commercial contracts make or break ASC economics. We build the strategy and leverage to secure in-network case rates, escalators, and terms that keep pace with your case mix and cost.
For ortho, spine, and cardiology, a single device can exceed the case rate. We structure carve-outs and invoice-plus terms that protect margin on high-cost cases.
Case-level modeling that turns claims and contracts into a clear view of what every payer actually pays per procedure.
A disciplined, evidence-based approach to out-of-network reimbursement and federal IDR — modeling when in-network conversion beats an OON position.
We ensure contractual entitlement becomes realized revenue — surfacing underpayments, methodology errors, and compliance gaps.
From new-center development to service-line expansion and hospital or physician joint ventures — we align growth with reimbursement reality.
ASC economics live in the fine print. These are the provisions Fulcrum models, negotiates, and defends in every surgery center agreement.
Invoice-plus reimbursement for high-cost implants so a single device never turns a case into a loss.
Choosing and structuring the payment methodology that best fits your case mix and cost profile.
Managing the 100% / 50% (and lower) reductions on subsequent procedures in the same session.
How procedures are grouped and priced — and where grouper logic quietly suppresses payment.
Annual rate escalators so multi-year agreements don't erode against cost inflation.
Eliminating lesser-of language that caps payment and enforcing prompt-pay obligations.
Language governing OON claims, QPA, and IDR — and the exposure it creates or removes.
Protections against third parties accessing your rates through undisclosed network rental.
Terms that reimburse newly covered procedures and codes as your service lines grow.
Notice, renegotiation triggers, and off-ramps that preserve leverage over the contract's life.
For implant-bearing specialties, carve-out terms can define the year. Model the annual recovery from moving your implant reimbursement toward invoice cost.
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Directional estimate for discussion only; not a guarantee of results. A Fulcrum analysis models your actual case mix, device costs, and contracts.
Independent by design and specific to the ASC model — case rates, carve-outs, and the payer behavior that decides your margin.
No networks, no downstream fees — only your economics.
Contract structures built for real ASC case economics.
Case-level modeling down to the procedure and device.
Insight into how payers treat ASCs in every market.
Platform-grade support for corporate and hospital-JV ASCs.
Disciplined NSA and arbitration strategy where it counts.
Quantified analysis behind every recommendation.
Dashboards and intelligence that clarify the path.
Executive briefings tuned to the surgery-center model — site-of-care economics, case-rate strategy, and the policy shifts moving procedures outpatient.
Tell us about your surgery center and the reimbursement challenge you're facing. A Fulcrum ASC advisor will follow up promptly.