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More than 1,000 ASC leaders met in Washington, D.C. last week for the ASCA + SAMBA Conference. Clinical sessions confirmed what most already knew. Volumes are up. The case list is growing. Ops sessions gave the harder message. The easy part of ASC growth is over. Strong systems now split growth from margin loss. Here is what the industry confirmed and what it means for H2 2026.
The Acuity Shift Is Permanent. Quality Records Start at Case One.
4,421 ASCs were evaluated for 2026 performance rankings. 911 centers earned a High Performing designation . That is up from 733 in 2025. The threshold also rose. Centers must now score in the top 15% to earn the HP rating. That was 10% last year. The bar is data-driven. It is getting harder to clear.
For 2026, U.S. News added shoulder cases to its Orthopaedics and Spine list for the first time. This reflects a real shift. Outpatient total shoulder volumes have grown four-fold in recent years. Better surgical tools and sedation made it safe. Cases that were hospital-only five years ago are now tracked and rated at ASCs. Spine fusions, cardiac cases, and complex revisions are on the same path.
The ratings use Medicare claims data from 2022 through 2024. Measures include ED visits, hospital stays, cost of errors, and post-acute care use. An ASC that starts shoulder cases today builds the record that 2028 and 2029 ratings will use. Waiting until volume ramps means losing two to three years of data. That gap affects HP status. It also affects whether payers and patients choose your center.
CERTIFY Health’s practice management system links scheduling, intake, and coverage checks. ASCQR quality data capture starts at the first case of any new type – not after a billing review finds a gap months later.
Getting Paid for New Cases Takes 6 to 10 Months After CMS Approval.
CMS added 560 codes to the ASC covered case list for 2026. That breaks down as 289 from revised criteria, 271 moved off the Inpatient-Only list, and 13 more from stakeholder requests. The new codes cover cardiac work, coronary cases, and spine fusions. These are the case types moving into ASCs right now.
CMS approval and first commercial payment are not the same event. Private payers write their own coverage rules. Those rules lag CMS by 60 to 180 days. Surgeon sign-on at a new site adds another 60 to 120 days. Add it up: the gap runs 6 to 10 months. During that time, Medicare pays. Private payer claims get denied. Not because of a clinical error. Because coverage is not yet active. Staff work appeals that cannot win yet. Finance teams ask whether the new case type even fits at the site.
The fix is not faster appeals. It is catching the gap before the case is booked. CERTIFY Health’s billing and RCM ops checks coverage at scheduling – not at billing. Surgeon status is confirmed before the first case goes on the books.
Revenue Integrity Pays Regardless of What Happens in Congress.
The case for ASCs has never been stronger. A Health study found that ASCs will cut Medicare costs by $73.4 billion from 2019 to 2028. ASCs do the same work at roughly half the cost of hospital outpatient departments. The CBO has put the savings from full site-neutral reform at $157 billion over 10 years. Policy is moving the right way. But policy does not collect revenue.
The Outpatient Surgery Access Act of 2026 was filed in March with cross-party House support. Reps. Van Duyne (R-TX) and Larson (D-CT) introduced it. It would lock in ASC pay updates at the hospital outpatient rate. It would also drop the budget cuts that hold ASC pay down. No Senate bill has been filed yet.
CMS has used the hospital market basket to set ASC rates every year since 2019. That is eight years in a row with no fix in law. The current term ends in 2026. The 2026 final rule also cut pay at off-campus hospital outpatient departments for drug admin, saving an estimated $280 million. If the Act passes, the gains add to growth. If rates drop to CPI-U, every billing gap gets worse. For an ASC taking in $1 to $5 million per month, that gap runs $60,000 to $300,000 per month. It is money on the table. Both paths favor fixing it now.
CERTIFY Health’s revenue cycle management software handles clean claim filing, denial prevention, and coverage checks. These tools cut billing gaps no matter what rates do.
Post-Conference Is the Payer Window. Act This Month.
May and June are the right time to open payer talks. The quality data is fresh. It is public. It is specific enough to anchor a rate deal.
ECG Management Consultants spoke on payer strategy at ASCA + SAMBA 2026. Their point: ASC success depends on contracts built with care and managed over time – not reacted to. Post-conference is the right time to start.
Top eye care centers averaged 40% fewer issues than the field. Top bone and joint centers saw 29% fewer. These are public, risk-adjusted results. You can put them on the table.
In California, top-rated eye care ASCs grew from 33 to 42 this year. Five new metro areas joined the top group: Baltimore, Dallas-Fort Worth, Kansas City, San Diego, and Seattle. If your center is in one of these markets, that rating is live contract leverage.
The M&A data adds more reason to move now. A financial valuation report shows that large, low-risk ASCs command EBITDA multiples of 8 to 10x. Smaller centers without strong billing and quality records land at 6 to 7x. That gap comes from solid systems and clean data. The same data package that lifts your valuation is your payer deal package.
An ASC that opens talks this month has fresh data and conference momentum. The same talk in Q3 or Q4 uses the same data. But rivals will have started their own outreach by then. The timing edge is gone.
CERTIFY Health’s billing and payment tools give finance teams a clear view of denial rates, revenue per case, and payer trends. Add ASCQR results and you have a rate talk built on proof. That is how revenue cycle management software earns its seat at the contract table – not just in back-office work. That is the moment revenue cycle management software becomes a growth tool.
The clinical case for ASCs is proven. The economics are solid. Policy is on your side. What splits growing margins from falling ones is strong systems – clean billing, clear quality records, and data to back them up. Schedule a billing and ops review to enter H2 2026 with your systems ready.
