How ASCs Can Strengthen Cash Flow Amid Industry Pressures: Insights from nimble solutions

Podcast Summary

Podcast: Becker’s Healthcare Podcast
Episode: How ASCs Can Strengthen Cash Flow Amid Industry Pressures: Insights from nimble solutions
Date: November 21, 2025
Host: Lucas Voss
Guests:

Tim Fusch, Chief Growth Officer, Nimble Solutions
Amanda Whitener, Senior Director of Client Development, Nimble Solutions

Episode Overview

This episode dives deep into strategies Ambulatory Surgery Centers (ASCs) can utilize to strengthen and accelerate cash flow amid ongoing industry pressures such as reimbursement challenges, rising costs, and complex payer dynamics. Tim Fusch and Amanda Whitener from Nimble Solutions share data-driven approaches, tactical revenue cycle management (RCM) tips, and actionable advice for ASCs to stay ahead in an evolving marketplace.

Key Discussion Points & Insights

1. The Importance of Accelerating Cash Flow for ASCs

Tim Fusch says the need for strong cash flow is more urgent than ever:
- Rising costs, shifting case mix, and payer pressures are converging (02:52).
- Quote:
  - “ASCs can’t afford to be reactive. The centers that win are the ones that continuously monitor their financial performance, pinpoint issues early and adjust quickly.” – Tim Fusch (02:54)
Daily data monitoring is essential:
- Go beyond monthly reports. Daily tracking of cash flow, denial trends, AR aging, net collection rates, and case profitability is critical (03:14).
- Identifying revenue leaks early can prevent future write-offs.
- Front end processes are crucial:
  - “70% of downstream revenue issues start before the patient enters the building.” – Tim Fusch (04:04)
- Automated eligibility checks, bulletproof authorization workflows, accurate patient estimates, and thorough financial counseling for high-deductible patients all help prevent denials and bad debt.

2. Tactical Strategies for Accelerating Cash Flow

Managed Care Contracting & Coding Integrity

Amanda Whitener emphasizes two avenues: Contracts & Coding (05:27)
- Many centers don’t have complete, up-to-date contracts.
- Common problem:
  - “Around 95 plus percent don’t have complete copies of their contracts when we initially engage them, which immediately tells me a few things…” – Amanda Whitener (05:46)
- Outdated contracts mean subpar fee schedules and overlooked payer carve-outs.
- Without contracts, billing teams can’t correctly process payments, leading to missed opportunities and compliance issues.
- Risks include incorrect handling of “lesser than” payment language, implant carve-outs, and routine chargemaster errors.
Importance of detailed coding and routine audits:
- Missed codes mean missed revenue, while mistakes (like a misplaced modifier) can cause audits or take backs.
- Quote:
  - “One coding mistake could cost thousands of dollars … even one misplaced 59 modifier could lead to a full-on audit.” – Amanda Whitener (08:35)
Streamlined RCM Processes:
- Diligence on prior authorizations, coding accuracy, up-front collection, and consistent use of accurate contracts is vital.
- Aim for “95+ percent clean claims on first pass – post payments based on contractual allowed amounts" (09:56).
- Strong back-end rapport with patients improves collection of remaining balances.

3. Top Financial Pressures and How to Stay Proactive

Cost pressures are dramatic:
- Implants and supplies: Up 8–20% (by specialty) (10:43)
- Staffing—especially anesthesia—faces industry-topping wage pressures.
- Technology and compliance costs rising.
Payer friction is increasing:
- More prior auth requirements, denials, and delayed appeal cycles.
**Competitive recruitment for surgeons is fierce; ASCs need strong value propositions.
Best performing ASCs leverage data and expertise:
- Financial education for staff and surgeons improves understanding of profitability by case and specialty.
- Ongoing staff training and real-time issue resolution are essential.
- Outsourced expertise (e.g., pre-certification, contract modeling, implant cost management) can deliver specialized value.
- Quote:
  - “Top ASCs really run those structured financial reviews … so problems are identified early and those leaders stay proactive, not reactive.” – Tim Fusch (13:54)

Notable Quotes and Memorable Moments

On the stakes of contract management:
- “Around 95 plus percent don’t have complete copies of their contracts … which tells me their contracts are likely out of date. That means less than par fee schedules, which is a huge opportunity for improvement of cash by way of payer negotiations.” – Amanda Whitener (05:47)
On the importance of data:
- “When you treat your data like a conversation instead of a report, you can spot the small issues before they turn into big problems.” – Tim Fusch (16:41)
On sticking to the fundamentals:
- “When margins are tight, the little things matter … Make sure your front-end teams are supported and trained, documentation is clean, and authorizations are handled right the first time.” – Amanda Whitener (15:07)
On seeking expertise:
- “Don’t be afraid to ask the ASC-specific experts and listen to what they have to say. Anybody in this industry knows that it’s very nuanced … There are specialists for each step of the revenue cycle.” – Amanda Whitener (15:37)

Timestamps for Important Segments

Introductions & Nimble Solutions overview – 00:29–02:31
Why accelerating cash flow matters now – 02:52–05:07
Key strategies for cash flow: contracting, coding, RCM best practices – 05:07–10:14
Current industry pressures & how ASCs can stay ahead – 10:43–14:32
Final advice for ASCs
- Amanda Whitener: Stick to fundamentals, leverage expertise – 15:05
- Tim Fusch: Stay curious about data, be proactive – 16:17

Key Takeaways

Daily financial monitoring and data analysis are no longer optional; they are critical for survival and success.
Contract management is a significant, often overlooked lever to improve cash flow.
Coding errors and out-of-date charge masters can cost ASCs thousands—routine audits are a must.
Front-end diligence (authorizations, eligibility, estimates) prevents downstream revenue loss.
Proactive, data-driven leadership and willingness to use specialized external help separate high-performing ASCs from the rest.
Fundamentals—training, compliance, process rigor—provide the confidence and resilience to thrive amid industry uncertainty.

Podcast Summary

Tim Fusch, Chief Growth Officer, Nimble Solutions
Amanda Whitener, Senior Director of Client Development, Nimble Solutions

Episode Overview

Key Discussion Points & Insights

1. The Importance of Accelerating Cash Flow for ASCs

Tim Fusch says the need for strong cash flow is more urgent than ever:
- Rising costs, shifting case mix, and payer pressures are converging (02:52).
- Quote:
  - “ASCs can’t afford to be reactive. The centers that win are the ones that continuously monitor their financial performance, pinpoint issues early and adjust quickly.” – Tim Fusch (02:54)
Daily data monitoring is essential:
- Go beyond monthly reports. Daily tracking of cash flow, denial trends, AR aging, net collection rates, and case profitability is critical (03:14).
- Identifying revenue leaks early can prevent future write-offs.
- Front end processes are crucial:
  - “70% of downstream revenue issues start before the patient enters the building.” – Tim Fusch (04:04)
- Automated eligibility checks, bulletproof authorization workflows, accurate patient estimates, and thorough financial counseling for high-deductible patients all help prevent denials and bad debt.

2. Tactical Strategies for Accelerating Cash Flow

Managed Care Contracting & Coding Integrity

Amanda Whitener emphasizes two avenues: Contracts & Coding (05:27)
- Many centers don’t have complete, up-to-date contracts.
- Common problem:
  - “Around 95 plus percent don’t have complete copies of their contracts when we initially engage them, which immediately tells me a few things…” – Amanda Whitener (05:46)
- Outdated contracts mean subpar fee schedules and overlooked payer carve-outs.
- Without contracts, billing teams can’t correctly process payments, leading to missed opportunities and compliance issues.
- Risks include incorrect handling of “lesser than” payment language, implant carve-outs, and routine chargemaster errors.
Importance of detailed coding and routine audits:
- Missed codes mean missed revenue, while mistakes (like a misplaced modifier) can cause audits or take backs.
- Quote:
  - “One coding mistake could cost thousands of dollars … even one misplaced 59 modifier could lead to a full-on audit.” – Amanda Whitener (08:35)
Streamlined RCM Processes:
- Diligence on prior authorizations, coding accuracy, up-front collection, and consistent use of accurate contracts is vital.
- Aim for “95+ percent clean claims on first pass – post payments based on contractual allowed amounts" (09:56).
- Strong back-end rapport with patients improves collection of remaining balances.

3. Top Financial Pressures and How to Stay Proactive

Cost pressures are dramatic:
- Implants and supplies: Up 8–20% (by specialty) (10:43)
- Staffing—especially anesthesia—faces industry-topping wage pressures.
- Technology and compliance costs rising.
Payer friction is increasing:
- More prior auth requirements, denials, and delayed appeal cycles.
**Competitive recruitment for surgeons is fierce; ASCs need strong value propositions.
Best performing ASCs leverage data and expertise:
- Financial education for staff and surgeons improves understanding of profitability by case and specialty.
- Ongoing staff training and real-time issue resolution are essential.
- Outsourced expertise (e.g., pre-certification, contract modeling, implant cost management) can deliver specialized value.
- Quote:
  - “Top ASCs really run those structured financial reviews … so problems are identified early and those leaders stay proactive, not reactive.” – Tim Fusch (13:54)

Notable Quotes and Memorable Moments

On the stakes of contract management:
- “Around 95 plus percent don’t have complete copies of their contracts … which tells me their contracts are likely out of date. That means less than par fee schedules, which is a huge opportunity for improvement of cash by way of payer negotiations.” – Amanda Whitener (05:47)
On the importance of data:
- “When you treat your data like a conversation instead of a report, you can spot the small issues before they turn into big problems.” – Tim Fusch (16:41)
On sticking to the fundamentals:
- “When margins are tight, the little things matter … Make sure your front-end teams are supported and trained, documentation is clean, and authorizations are handled right the first time.” – Amanda Whitener (15:07)
On seeking expertise:
- “Don’t be afraid to ask the ASC-specific experts and listen to what they have to say. Anybody in this industry knows that it’s very nuanced … There are specialists for each step of the revenue cycle.” – Amanda Whitener (15:37)

Timestamps for Important Segments

Introductions & Nimble Solutions overview – 00:29–02:31
Why accelerating cash flow matters now – 02:52–05:07
Key strategies for cash flow: contracting, coding, RCM best practices – 05:07–10:14
Current industry pressures & how ASCs can stay ahead – 10:43–14:32
Final advice for ASCs
- Amanda Whitener: Stick to fundamentals, leverage expertise – 15:05
- Tim Fusch: Stay curious about data, be proactive – 16:17

Key Takeaways

Daily financial monitoring and data analysis are no longer optional; they are critical for survival and success.
Contract management is a significant, often overlooked lever to improve cash flow.
Coding errors and out-of-date charge masters can cost ASCs thousands—routine audits are a must.
Front-end diligence (authorizations, eligibility, estimates) prevents downstream revenue loss.
Proactive, data-driven leadership and willingness to use specialized external help separate high-performing ASCs from the rest.
Fundamentals—training, compliance, process rigor—provide the confidence and resilience to thrive amid industry uncertainty.

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Summary

Podcast Summary

Episode Overview

Key Discussion Points & Insights

1. The Importance of Accelerating Cash Flow for ASCs

2. Tactical Strategies for Accelerating Cash Flow

Managed Care Contracting & Coding Integrity

3. Top Financial Pressures and How to Stay Proactive

Notable Quotes and Memorable Moments

Timestamps for Important Segments

Key Takeaways

Summary

Podcast Summary

Episode Overview

Key Discussion Points & Insights

1. The Importance of Accelerating Cash Flow for ASCs

2. Tactical Strategies for Accelerating Cash Flow

Managed Care Contracting & Coding Integrity

3. Top Financial Pressures and How to Stay Proactive

Notable Quotes and Memorable Moments

Timestamps for Important Segments

Key Takeaways