A growing number of ambulatory surgery centers are outsourcing billing and revenue cycle management, chasing the promise of fewer denials and lighter workloads for internal teams. On paper, this makes sense. Offload the complexity, reduce FTE burden, and let someone else navigate the payer maze.

But in practice, it introduces a subtle and dangerous gap beyond just the operational cost of supporting an ASC billing agency.

Suddenly, the team managing your claim is no longer in the building. They’re three times removed from the surgeon performing the procedure. The workflow becomes a game of telephone: clinical team → internal auth rep → outsourced vendor → payer, and back again. Each handoff adds friction, latency, and the very thing you're trying to avoid: denial exposure.

The problem isn’t just logistical. It’s fundamental. These vendors aren't embedded in the day-to-day clinical operations. They don’t overhear the side conversations or pick up on the nuance in a diagnosis note. They can't pop into the surgeon's office or flag a detail to the RN who saw the patient pre-op, so context gets lost and documentation becomes more fragmented. And with it, accountability slips through the cracks.

It’s what happens afterwards that is measurable in financial and operational impact. When a denial (either a soft or firm denial) arrives, ASCs and their surgeons have a few options. Surgeons are told to initiate peer-to-peer reviews for a case that’s already been performed, or the surgery center bills at self-pay rates to patients or writes-off the case entirely.

Outsourcing might reduce short-term workload, but it doesn’t eliminate the core challenge: clearing a case accurately and efficiently, with the right documentation, the first time. If anything, it creates a longer feedback loop, and by the time you realize something’s missing, you’re already behind.

Meanwhile, Payers Are Using AI to Accelerate Denials

While provider organizations are adding more intermediaries, payers are doing the opposite - using AI to automate and accelerate denials. And they’re doing it without clinician input.

• A 2023 ProPublica investigation revealed that Cigna’s internal review system, PXDX, was denying claims in bulk, sometimes without any medical records being reviewed. One medical director denied over 1,400 claims in under two months using preset rules and templates that bypassed clinical judgment. (ProPublica)
• EviCore, a Cigna subsidiary and one of the largest prior-auth vendors in the U.S., uses proprietary AI to make clinical determinations across imaging, cardiology, and musculoskeletal care. Physicians have raised alarms about medically necessary procedures being denied due to outdated or overly rigid criteria. (ProPublica)
• UnitedHealthcare has faced lawsuits over its use of algorithms to reduce rehab days following surgery, allegedly overriding provider recommendations and prematurely discharging patients based on opaque AI rules. (CBS News)

So Why Aren’t Providers Using Technology to Push Back?

If payers are using automation to deny faster, providers need to be using automation to clear faster.

There’s a smarter way to approach financial clearance where intelligent systems surface documentation gaps early, before the claim ever reaches the payer. Where automation supports the team in real-time, not retroactively. Where technology restores context rather than eroding it.

Instead of layering on third parties who operate in silos, healthcare organizations need tools that integrate inside the clinic. Solutions that flag missing documentation at the point of intake. Systems that understand procedure codes, payer rules, and site protocols. Teams that operate in sync, not in relay.

Federal Standards Signal a Turning Point

There’s also momentum building at the policy level.

In June 2025, 75% of U.S. insurers (e.g. UnitedHealthcare, Aetna, Cigna, and Blue Cross Blue Shield) pledged to streamline prior authorization by implementing:

• Real-time electronic approvals by 2027
• Reduced prior-auth requirements by 2026
• 90-day authorization validity, even when patients switch plans

While these standards are voluntary, they signal a significant shift toward systemic reform and more collaborative payer-provider workflows. But it’s not enough to wait. Provider organizations should be building internal infrastructure now to meet this moment. (New York Post)

The Bottom Line

Outsourcing financial clearance may offer short-term relief from internal pressure, but it often sacrifices clarity and accountability, increasing the time it takes to move from consultation to operating room. Every additional handoff adds risk and every missing piece of documentation adds cost. Add on that every delay adds friction to a system that patients and providers alike are already struggling to navigate.

Instead, Ambulatory and Outpatient Surgery Centers should consider:

• Embedding authorization teams directly into clinical workflows
• Investing in AI and automation tools that flag missing documentation early — before the claim is ever submitted
• Aligning with national reform efforts to simplify the path between care delivery and reimbursement

The true goal is faster clearance and frictionless care.