Ahead of Becker’s ASC: Kathy Saunders on Denials, Underpayments and Scaling RCM in Orthopedics

Why It Matters

Enhanced analytics give orthopedic providers a clearer view of payer behavior, allowing them to capture lost revenue and scale without overtaxing staff—a critical advantage in a competitive ASC market.

Key Takeaways

• Adonis analytics turns denial review from claim-by-claim to batch insights
• Proactive payer monitoring caught a CPT guideline change, preventing claim pile‑up
• Underpayments arise when new physicians lack correct contracted rates
• Staff burnout linked to low‑value E&M claims versus high‑value surgeries
• Integrated Adonis with athenahealth gives real‑time revenue visibility

Pulse Analysis

Orthopedic ambulatory surgery centers (ASCs) face a perfect storm of revenue‑cycle challenges: rising denial rates, opaque payer rule changes, and chronic staffing shortages. Traditional claim‑by‑claim reviews are too slow to keep pace with frequent guideline updates, especially for high‑value spine and joint procedures that dominate an orthopedic practice’s revenue mix. When denials slip through, they not only delay cash flow but also increase administrative overhead, compounding the burnout already felt by billers juggling low‑margin evaluation‑and‑management (E&M) work.

Enter advanced analytics platforms like Adonis, which integrate directly with athenahealth’s electronic health record. By aggregating claim data in real time, Adonis surfaces denial trends, payer‑specific guideline shifts, and underpayment flags before they become systemic issues. This proactive stance transforms the revenue cycle from a reactive firefighting model to a predictive one, allowing teams to retrain staff, adjust coding practices, and renegotiate contracts swiftly. The result is a measurable reduction in denial turnaround time and a clearer picture of expected reimbursements, giving finance leaders the confidence to allocate resources toward growth initiatives rather than damage control.

For orthopedic groups eyeing expansion—whether adding new surgeons, opening additional ASCs, or scaling multi‑specialty services—the ability to capture every dollar matters. Underpayments tied to new physician onboarding can erode margins for months if not identified early. By leveraging real‑time visibility into payer behavior, practices can protect revenue streams, streamline staffing focus on high‑value surgeries, and mitigate burnout. In an environment where payer contracts are increasingly complex, the combination of robust analytics and integrated EHR data is becoming a non‑negotiable component of sustainable growth.