For ambulatory surgery centers (ASCs) looking to expand in 2026, the operational decisions to add a new specialty, recruit another surgeon or open a new facility may be the easiest part of the growth equation.
Getting paid appropriately for that growth is often much more difficult.
That was one of the main takeaways from a recent ASC News webinar on expansion, where industry revenue experts warned that managed care contracting, credentialing and reimbursement processes often trail the pace of ASC growth. In turn, surgery centers are frequently exposed to underpayments and other revenue issues, including denials.
“We still encounter a lot of ASCs [that are] really unprepared for what’s to come [as they grow],” Scott Allen, senior vice president of managed care contracting at Nimble Solutions, said during the webinar. “If it’s adding new services, a new contract, oftentimes not even having the basics [down first].”
Revenue-capture challenges often materialize before a case is ever scheduled, Allen explained. Centers need complete contract files, current fee schedules, payer crosswalks and a clear understanding of notice requirements and payment terms before expanding into new service lines, he said.
In short, there’s a lot of boxes operators need to check before they dive in.
“You have to understand what that overhead cost is very, very carefully to make sure that if you allow the surgeon to bring a case over tomorrow, you’re not losing money,” Allen said.
“A lot of times … we see physicians just wanting to bring a case to the ASC for whatever reason,” he continued. “Maybe it’s a scheduling situation. Maybe they’re unhappy with the hospital at that point. It’s just, ‘Let’s bring it over.’ And without even doing the homework, you know, this is where you end up losing quite a bit of money.”
That risk becomes even greater as ASCs push into more complex cases.
Jessica Thurston, vice president of client development at Nimble Solutions, confirmed that many operators are not just adding new specialties, but also moving deeper into higher-acuity procedures within existing ones.
“I would say it’s more complex procedures, right?” Thurston said. “I might have already been seeing orthopedics, but I’m really leaning into a total joint program.”
With that, an ASC may bring on different or more physicians, which has a ripple effect. Different physicians have different preferences and behaviors, such as how they utilize implants, for example.
“I think that goes back to the importance of really understanding the data on where those procedures are currently being performed and actually getting your hands on the data, so that way you have the specific CPT codes as well to better analyze,” Thurston said. “To have that true apples-to-apples comparison of what’s going to be migrated over.”
Indeed, that kind of expansion can quickly expose weaknesses in a center’s data, payer setup and front-end workflows, according to Allen and Thurston.
And seemingly routine system issues can undermine reporting and reimbursement analysis later.
“The system readiness is key,” Allen said.
For de novo centers, the financial lag can be especially pronounced. Accreditation, credentialing and payer negotiations can stretch for months, with some operators feeling pressure to accept weak early contracts just to start generating revenue, Allen said.
“You absolutely can’t sign that first contract [if it doesn’t make financial sense],” he said. “It’s never easy to work your way back up that ladder.”
The broader message for ASC leaders during the webinar was that growth strategy now has to extend beyond physician recruitment and clinical capacity. It also has to include contract modeling, charge capture, payer notification and underpayment detection.
“Data is king here,” Thurston said. “When you’re analyzing what makes sense to be brought to the surgery center, just really doing your homework ahead of time and really understanding the true numbers, I think, will help set you up for success.”
