This article is sponsored by nimble solutions. As ASCs face tighter margins, shifting reimbursement, and growing case complexity, leaders are rethinking the way they manage revenue. nimble solutions is bringing a fresh, ASC-first approach to the table, built to reduce inefficiencies, protect margins, and support long-term growth. In this Voices interview, Kelley Blair, CEO of nimble solutions, shares the insights that shaped her leadership, what’s driving performance across today’s top surgery centers, and how purpose-built RCM can help ASCs thrive in 2026 and beyond.
Ambulatory Surgery Center News: What core insight or career experience gave you the lens you have today on the ASC landscape?
Kelley Blair: I’ve spent more than 30 years in health care, primarily focused on revenue cycle, and I’ve had the opportunity to work across a wide range of settings. That includes large health systems and IDNs, and now ambulatory surgery centers. Having that breadth of experience has given me a much deeper appreciation for how the entire care continuum fits together.
As more care continues to shift out of acute settings and into the ambulatory space, that perspective has been especially valuable. I’ve been able to see firsthand how operational, financial, and clinical dynamics change as you move into ASCs, and how different the demands are. That broader view has really shaped how I approach the ASC landscape today and how I think about supporting organizations as they navigate that transition.
With experience across multiple health care settings, what did working closely with ASCs reveal to you about how different their revenue cycle really is? And how does that insight shape your focus on innovation as CEO of nimble?
Working closely with ASCs made it very clear just how little margin for error they have. Volumes may be high, but reimbursement is tight, and many centers are fronting the cost of implants and other supplies out of pocket. That makes consistent, predictable cash flow critical. It’s not abstract. It can directly affect whether a center can see patients or make payroll in a given month.
Unlike large health systems, ASCs don’t have massive back offices that can absorb inefficiencies. When something breaks in the revenue cycle, whether it’s eligibility, authorizations, coding, or payer denials, the impact is felt almost immediately. There’s a real sense of urgency that comes with that. Most of our clients are physician-owned, so they’re deeply engaged not just in clinical care, but in financial performance as well. They understand how tight margins are and how much every decision matters month to month.
That dynamic shapes how we think about partnership at nimble. Our clients expect transparency, speed, and control, and they want partners who care about their business as much as they do. It’s a much more intimate relationship than you see in other parts of health care, because their success is directly tied to ours.
That’s also what led us to focus on cash per case. Traditional revenue cycle metrics like how quickly a claim closes aren’t enough for ASCs. They need confidence that every dollar tied to the care they deliver is being captured and reimbursed appropriately. Our focus is making sure they’re not just getting paid, but getting paid fully and accurately for the value they provide, and aggressively addressing anything that stands in the way of that.
You’ve seen ASCs navigate changes in reimbursement, rising case complexity and shifting payer behavior. Which shifts have had the biggest impact on financial performance, and what challenges have stayed consistent?
It’s exciting to see more procedures continuing to move from the acute setting into the ambulatory environment. Many of these cases are more complex and higher acuity, which can be a revenue opportunity for ASCs and help offset some of the financial pressures we’ve talked about. At the same time, reimbursement hasn’t necessarily kept pace with that complexity, and there’s a growing administrative and operational burden that comes with taking on these advanced procedures.
That’s something we work through closely with our clients, especially when they’re considering expansion into new specialties. It’s not just about clinical capability. It’s about how you optimize OR time, what upfront investments are required, and how those investments compare to realistic reimbursement expectations. Those decisions have a direct impact on financial performance.
Payer behavior has also become more variable. That’s not unique to ASCs, but it’s felt more acutely in this setting. Payers are introducing tighter preauthorization requirements, more edits, and more scrutiny overall. On top of that, there’s significant variation by state and by individual contract, which adds another layer of complexity. While that complexity isn’t new, it has a much bigger impact as procedure mix expands.
Because of that, contract strategy has become increasingly important. We spend a lot of time working with clients to understand not just whether a contract looks good on paper, but whether it’s actually executable. The goal is to ensure reimbursement rates are competitive and that claims can realistically be processed and paid without excessive friction. As ASCs take on more complex cases, that combination of reimbursement alignment and operational execution becomes even more critical.
As complexity increases and as margins tighten, ASCs are being asked to do more with less. Where do you see the biggest opportunities to reduce inefficiencies and protect revenue while keeping clinical teams focused on patient care?
There’s definitely a significant opportunity on the front end of the revenue cycle. Eligibility verification and benefits checks remain foundational, especially as benefit designs become more complex and patients shoulder more financial responsibility. It’s also critical to have a clear understanding of payer authorization guidelines and to make sure those authorizations are obtained correctly and consistently. Missing or insufficient authorizations are still one of the top drivers of denials we see.
As employers look to control costs, benefit structures are getting more complicated, which makes front-end accuracy even more important. Making sure benefits are truly available and clearly understood before the case happens protects both the ASC and the patient experience.
That said, the broader shift we encourage is looking at revenue through a cash-per-case lens. Front-end workflows matter, but it starts even earlier with payer contracts. ASCs need to be confident that their coding and documentation accurately reflect the complexity of the procedures they’re performing, because you can only get paid for what’s ultimately coded and submitted on the claim. From there, it’s about ensuring those services are properly authorized and then pursuing reimbursement aggressively and consistently.
We focus on this across all of our clients, and we’ve seen real impact. In one recent example, an ASC increased its cash per case by 17% in just three months by tightening front-end authorization workflows, strengthening documentation around medical necessity, and being far more proactive with payer follow-up when denials occurred. That follow-up is especially important because over time, it can actually influence payer behavior. When you consistently submit strong documentation and challenge inappropriate denials, you can reduce the volume of future requests and denials, which ultimately protects revenue while allowing clinical teams to stay focused on patient care.
Many RCM solutions were built for hospitals or physician practices, and later adapted for ASCs. From your perspective, what differentiates a revenue cycle partner truly built for surgery?
One of the biggest differences is that revenue cycle in an ASC includes additional layers that simply don’t exist in the same way in hospitals or large physician groups. In a hospital setting, the revenue cycle is often focused on managing the bill and the claim transaction, with separate teams handling contracting, pricing, and clinical documentation. In an ASC, because every dollar matters, all of those elements come together.
A revenue cycle partner built for surgery has to look beyond just processing claims. That means stepping back and asking fundamental questions like: What does your payer contract actually allow? Is your documentation fully reflecting the complexity of the procedures being performed? Have you optimized pricing so you’re being paid appropriately for the care you deliver? Those foundational pieces determine whether the transaction side of the revenue cycle will be effective at all.
ASCs are also uniquely procedure-driven. You have to understand implant billing, specialty-specific reimbursement nuances, and the reality that many surgeons are performing newer or more advanced procedures. That often means working with unlisted codes and navigating reimbursement pathways that aren’t straightforward. Helping clients pursue appropriate payment in those situations requires deep focus and expertise on a claim-by-claim basis.
Because ASC care is so specialized and margins are tight, that level of attention isn’t optional. When those upstream elements are handled correctly, it leads to stronger cash per case and more predictable cash flow. And that’s what ultimately allows ASCs to reinvest in their facilities, support their teams, and continue to grow sustainably.
Looking ahead to 2026 and beyond, what are you seeing among nimble’s customers that signals success in the ASC space? And what approaches are setting today’s top performers apart?
I think the most successful ASC operators we’re seeing are becoming far more disciplined and data-driven. We spend a lot of time educating our clients around core revenue cycle metrics and giving them financial insight to understand where payer behavior, case mix shifts, and reimbursement trends are impacting performance. That kind of visibility is critical, especially as organizations look to grow.
Standardization is another big differentiator. Tightening financial controls, creating more consistent operational processes, and using real-time insights to identify issues earlier allows teams to react faster instead of playing catch-up. When you can see problems as they’re emerging, rather than weeks or months later, you’re in a much stronger position.
Many of our customers are also preparing for greater participation in value-based care by improving cost visibility and outcomes tracking. That alignment between clinical and financial teams is becoming increasingly important. ASCs not only need to demonstrate that they can deliver care at a lower cost than hospitals, but that they can also produce strong outcomes and measurable results. Ultimately, that’s what payers care about.
Across all of this, the common thread is data. The centers that are collecting the right data and using it effectively to guide decisions are the ones driving stronger performance today and positioning themselves for long-term success.
If you could give one piece of forward-looking advice to others in your space as 2026 takes shape, what would it be?
I think the biggest piece of advice would be to truly understand your payer relationships and treat them as a strategic priority. Decisions around which payers you contract with, which networks you participate in, and how you structure those agreements have a direct impact on financial performance. We’ve seen a big swing in recent years with organizations choosing to go out of network in certain cases, and those decisions can work, but they need to be made very intentionally.
At the end of the day, the cash is coming from the payer. That reality makes it critical to build and leverage strong payer partnerships and to be thoughtful about how those relationships are set up. Understanding reimbursement dynamics, authorization requirements, and contract terms upfront gives ASCs far more control over their financial outcomes.
We really see payer strategy as the starting point for success. When organizations take a proactive, informed approach to payer relationships, everything else, from cash flow to growth planning, becomes much more manageable and predictable.
Editor’s note: This interview has been edited for length and clarity.
Learn more about nimble solutions and request your no-cost RCM Assessment at nimblercm.com
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].