Generalist RCM is why you have a denial problem. The ASP-RCM answer: specialty-staffed pods.
Every specialty has its own coding rules, payer behavior, and documentation traps. ASP-RCM staffs teams by specialty, not by client size. Your senior ASP-RCM partner has 15+ years in your world, not someone else’s.
Where we’ve done the most damage to denials.
Four specialty teams that handle the largest portion of our portfolio. Each has its own playbook, payer-rule library, and senior partner.
ABA Therapy Billing 50-state coverage
Authorization-driven, units-heavy, and audit-targeted. From a single BCBA-led clinic to multi-state ABA networks: same dedicated pod, same senior accountability, denial rate consistently under 3%. Dedicated state guide for every U.S. market, with state-specific Medicaid programs, dominant Blue plans, MCO contracting wrinkles, and BCBA credentialing benchmarks.
- Concurrent authorization tracking across plans
- 97155, 97153, 97156 modifier & unit precision
- Treatment-plan documentation review
- Single-case agreements & out-of-network billing
- BHCOE channel partner; only RCM firm we know of with one
- Live 52-jurisdiction payer matrix; refreshed monthly
Hospital & Health System Billing
UB-04, DRG, observation vs inpatient, transfer DRG: the full hospital RCM stack, run by senior partners who’ve managed billing departments at 4-hospital systems.
- Inpatient, outpatient, ED, observation, surgical
- DRG validation & transfer DRG capture
- 340B compliance & audit defense
- Provider-based billing & split-billing rules
- 4-hospital system case study available
Mental Health & Behavioral
Outpatient psych, IOP, PHP, residential, telehealth: we handle the full continuum. Authorization workflows, level-of-care transitions, and parity-act underpayment recovery.
- Outpatient, IOP, PHP, residential, inpatient psych
- Level-of-care transition documentation
- Parity Act underpayment recovery
- Telehealth billing across 50 states
- 14-location outpatient psych case study available
Physician Group Billing
Multi-specialty groups, IPAs, and ACOs. E/M leveling, surgical bundling, modifier discipline, and HCC capture, with provider-level documentation feedback baked in.
- E/M leveling (99202-99215) at audit-defendable accuracy
- Surgical CPT bundling & modifier 24/25/57/59
- HCC risk-adjustment coding for MA contracts
- Provider-level documentation coaching
- 62-provider multi-specialty case study available
34 more specialty playbooks in production.
Don’t see yours? Ask. We’ve probably got a senior lead with 15+ years in it.
FQHC / Community Health
PPS rate billing, sliding-fee, scrubbing for HRSA & UDS reporting compliance.
SNF / LTC
PDPM coding, MDS validation, dual-eligible billing, Medicaid pending workflows.
DME / HME
CMN tracking, recertification deadlines, PA-driven billing for CGM, CPAP, mobility.
Urgent Care
S9083, observation rules, occupational health splits, walk-in eligibility velocity.
Home Health & Hospice
OASIS-D timing, PDGM episode billing, hospice cap management, GIP/IRC distinctions.
Anesthesia
Time-unit billing, base-unit accuracy, modifier QK/QY/QX/QZ, CRNA supervision rules.
Radiology
Professional/technical splits, modifier 26/TC, RVU optimization, advanced imaging PA.
Pathology
88305 series accuracy, technical/professional, molecular pathology PA workflows.
Lab & Diagnostics
14-day rule, PAMA reporting, NCD/LCD review, molecular genomics billing.
Cardiology
Cath lab bundling, EP procedures, modifier 51/59, device monitoring follow-up.
Orthopedics
Global period management, hardware coding, DME splits, workers’ comp workflows.
Gastroenterology
Screening vs diagnostic colon, modifier PT/33, anesthesia pairing, ASC splits.
OB/GYN
Global OB packaging, antepartum-only, delivery types, fetal monitoring rules.
Pediatrics
VFC vaccine billing, well-child documentation, EPSDT, school-based health.
Dermatology
Mohs surgery, biopsy bundling, cosmetic vs medical, telederm workflows.
Urology
Cystoscopy, robotic surgical, in-office procedures, UroLift & advanced therapies.
Neurology
EEG/EMG units, infusion therapy, MS specialty drug billing, telehealth coverage.
Oncology & Hematology
Drug-acquisition margin, infusion timing, OCM/EOM contracts, biosimilar substitution.
Pain Management
Injection bundling, modifier 50/RT/LT, PDMP compliance, Medicare LCD navigation.
Physical Therapy
8-minute rule, CQ/CO modifiers, plan of care recertification, MIPS reporting.
Optometry / Ophthalmology
Vision vs medical, refraction billing, post-op modifier 24, intravitreal injections.
Dental / Oral Surgery
Medical-to-dental cross-coding, sleep apnea appliance, sedation, OMS workflows.
Allergy & Immunology
95004 testing units, vial preparation 95165, immunotherapy administration coding.
Plastic / Reconstructive
Medical-necessity documentation, cosmetic carve-outs, breast reconstruction WHCRA.
Podiatry
Routine foot care exclusions, Q7/Q8/Q9 modifiers, diabetic care coverage rules.
Chiropractic
AT modifier discipline, active treatment vs maintenance, CMT level coding.
Ambulance / EMS
BLS/ALS levels, mileage capture, point-of-pickup rules, signature requirement.
ASC / Surgery Centers
Implant billing, multiple-procedure reduction, packaging vs separate, modifier 50.
Nephrology / Dialysis
MCP billing, ESRD bundled rate, home-dialysis training, transplant follow-up.
Infusion / Specialty
Drug acquisition margin, J-code precision, NDC mapping, prior-auth for biologics.
Wound Care
Hyperbaric oxygen, Q4-series skin substitute billing, debridement depth coding.
Telehealth / Virtual Care
POS-02/10, modifier 95/93, state licensure compliance, asynchronous billing.
Don’t see yours?
We’ve probably got a senior partner with 15 years in it. Ask.
13 physician specialties, each with dedicated state guides.
Physician-led practices and groups across 13 specialty verticals. Each pillar carries 51 state guides with NPPES market data, state Medicaid program specifics, dominant commercial payer mix, and specialty-specific operating discipline.
Cardiology Billing
Professional/technical component splits, complex E/M, cardiac device monitoring, EP procedure coding.
Orthopedic Billing
Bundling edits, modifier 25/59, 90-day global periods, MRI/DME PA, workers comp workflow.
Oncology Billing
Infusion administration coding, J-code drug billing under ASP+6, NCCN-aligned PA, EOM, 340B.
Urology Billing
In-office procedure billing, modifier 25 discipline, robotic surgery, BPH treatment, GU drugs.
Dermatology Billing
Lesion removal by size/method, Mohs stage billing, cosmetic/medical separation, biologic PA.
OB-GYN Billing
Global OB package, delivery coding, OB ultrasound, well-woman preventive, LARC, pelvic surgery.
Pediatrics Billing
Well-child + vaccine billing, EPSDT screening, BH integration, sick visit + procedure mod 25.
Optometry & Ophthalmology
Ophth vs medical E/M, refraction separation, cataract + IOL, OCT/fundus/VF, Medicare vision rules.
Radiology & Imaging
26/TC discipline, autonomous coding maturity, RBM-driven PA, AUC/CDS compliance, IR coding.
Pain Management
Injection procedure coding, imaging guidance, medical necessity, PDMP, implantable devices.
Urgent Care Billing
S9083 vs E/M routing, modifier 25, POC lab + imaging, telehealth billing, occupational health.
Ambulatory Surgery Center
Medicare ASCFS, device pass-through, charge capture vs case logs, PA discipline, OON strategy.
Multispecialty Group
Cross-specialty coding, provider E/M consistency, internal referral workflow, value-based reporting.
Therapy specialties with distinct billing mechanics.
Physical, occupational, speech-language pathology, and audiology bill under different rules than physician practices: 8-minute rule for timed codes, discipline-specific modifiers (GP/GO/GN), Plan of Care recertification cycles, KX modifier above therapy thresholds, and Medicare outpatient vs home health distinctions.
Physical Therapy
8-minute rule, GP modifier, Plan of Care recert, KX modifier, outpatient/home health distinction, state direct access rules.
Occupational Therapy
8-minute rule, GO modifier, Plan of Care recert, KX modifier, pediatric + school-based billing, specialty OT coding.
Speech & Audiology
8-minute rule, GN modifier, Plan of Care recert, KX, audiology evaluations + hearing aid billing, pediatric SLP.
Standalone billing categories with their own operating reality.
Dental, pharmacy, and chiropractic each operate under billing rules that don't map cleanly to physician practice. Dental crosses CDT and CPT; pharmacy navigates 340B + DIR fees + specialty PA; chiropractic carries discipline-specific modifier discipline and WC/auto workflow.
Dental Billing
CDT + CPT crossover billing, pre-treatment estimates, benefits accumulator tracking, in-network vs OON strategy, Medicaid dental, implant case management.
Pharmacy Billing
Specialty pharmacy PA, 340B inventory tracking, DIR fee management, compounding accuracy, MTM clinical services, patient assistance coordination.
Chiropractic Billing
CMT region coding, active vs maintenance distinction, AT modifier for Medicare, therapy modality + procedure billing, WC + auto/PIP workflow.
Want a senior partner who actually knows your specialty?
30 minutes. They walk your last 90 days of denials, through the specific lens of your specialty’s payer rules and audit risks.