Proliferation of Ambulatory Surgery Centers Is Reshaping Outpatient Care — and Raising the Stakes for Payors

August 05, 2025 Ambulatory Surgery Centers (ASCs) are expanding at record pace and for hospitals, private equity firms and physician networks, they're a smart bet. These lower-cost settings promise operational efficiency, faster procedures and bigger margins.

However, for employers, TPAs and stop-loss carriers, the growth of ASCs introduces a new layer of financial risk, steeper charges, more aggressive coding and fewer negotiation options. What was once seen as a cost-saving alternative is becoming a hotspot for inflated claims and limited transparency.

This shift is already underway. While the site of care for healthcare services and drug administration is changing, the pressure on plan costs continues to grow. Cost containment is essential and staying ahead requires focused and proactive oversight.

Why ASCs Are Surging and What It Means for Payors

Across the country, health systems are rapidly expanding their ASC networks. The drivers are clear: proposals for site-neutral payments, growing pressure from commercial insurers to lower costs and overcrowded hospital operating rooms are all accelerating the shift. At the same time, private equity and investor-backed platforms are pouring capital into ASCs, eyeing fast returns and aggressive margin growth.

As a result, more procedures are being pushed into outpatient settings. These centers are increasingly owned and operated by entities whose primary goal is financial performance, not patient affordability. That means a higher volume of outpatient claims and more complexity in how those claims are billed and managed.

For payors, this shift brings real risk. With fewer concessions at the negotiating table, more aggressive coding practices and opaque pricing structures, the ASC landscape is becoming less about savings and more about protecting provider revenue. The billing environment is changing fast and it's rarely in the payor's favor.

What H.H.C. Group Is Seeing in ASC Claims

H.H.C. Group's clinical and negotiation teams are observing consistent and concerning patterns across high-volume ASC claims, trends that signal growing risk for payors.

There has been a significant increase in upcoding and modifier stacking, with many ASCs billing procedures at the highest complexity levels. In many cases, supporting documentation is lacking, yet these inflated charges often go unchallenged without proper oversight.

Out-of-network billing is also prevalent, especially in emergency-adjacent or specialty care settings where patients have limited provider options. This practice drives up claim costs and increases the likelihood of balance billing and legal exposure for health plans.

Another trend is the lack of pricing transparency. Unlike hospitals, ASCs frequently operate with proprietary rate structures rather than standardized benchmarks. This makes it more difficult for payors to evaluate or contest charges.

In addition, ASC negotiations have become more rigid. Providers backed by private equity or integrated health systems often adopt firm pricing positions and are supported by legal teams, leaving little room for compromise.

Together, these factors are turning ASC claims into high-stakes, complex transactions. Without expert intervention, inflated costs can easily go unchecked, placing significant strain on plan resources and eroding cost control.

How H.H.C. Group Keeps Payors Protected

H.H.C. Group has decades of experience navigating complex claims, inflated billing and aggressive provider tactics and the rise of ASC-related challenges is no exception.

Attorney-Led Negotiation: H.H.C. Group's seasoned negotiation team engages providers directly, armed with benchmark data, legal precedent and billing intelligence. This approach routinely delivers reductions of up to 90% on high-dollar outpatient claims.

Independent Clinical and Financial Review: Every claim is subject to in-depth scrutiny. The URAC-accredited review team evaluates medical necessity, verifies coding accuracy and identifies unjustified charges — ensuring that payments reflect actual care, not inflated documentation.

Reference-Based Pricing and Repricing: Rather than accept inflated or proprietary fee schedules, H.H.C. Group anchors reimbursements to Medicare benchmarks and regional market data, providing clients with a transparent, defensible basis for fair payment.

PPO Access + Smart Claim Routing to Maximize Savings
When advantageous, H.H.C. Group taps into major Preferred Provider Networks to leverage existing agreements and further reduce spend. Even claims as small as $1 are repriced and routed through the most cost-effective path—because every dollar counts.

Fast Turnaround Times: With most claims resolved in just 5–7 business days, H.H.C. Group empowers clients to act quickly and confidently, without sacrificing accuracy or oversight.

Signed Provider Agreements
We secure 100% signed agreements on every negotiation to eliminate balance billing, lock in savings, and protect plan participants.

30 Years of Proven Results
With a proven 30-year track record of successfully negotiating both in- and out-of-network facility claims, H.H.C. Group remains a trusted partner for cost containment nationwide.

The ASC Boom Isn't Slowing Down — Neither is H.H.C. Group

As more procedures move outpatient, payors can't afford to assume that ASC equals automatic savings. Without active review, strategic negotiation and benchmark-based pricing, costs can rise just as fast and with fewer tools to contain them.

H.H.C. Group keeps you ahead of the curve with real insight, real savings and a team of experts ready to take on every claim, no matter how quickly the market shifts.

Contact us to learn how we help self-insured plans, stop-loss carriers and TPAs control costs — even in today's ASC-driven market.

Real People. Real Savings. Real Strategy.