← Back to 52-Portal Commercial Payer MRF & NSA IDR Directory
RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
MU
MUNICIPAL-ASC-RCM-2026-09
•
Multi-State Self-Funded Municipal / Public Employee Health Plan & Commercial ASC Network Index
•
Multi-State Regional MSA
•
Filing / IDR Window: 2026-12-04
[MUNICIPAL-ASC-RCM-2026-09] Multi-State Ambulatory Surgery Center (ASC) Payer Contract Renegotiation, 835 Underpayment & GFE Compliance Audit
Commercial payer fee-schedule renegotiation leverage dossier quantifying the 58% site-of-service cost savings of shifting orthopedic, spine, pain management, and GI surgical volume from Hospital Outpatient Departments (HOPDs) to independent Ambulatory Surgery Centers (ASCs), paired with implant carve-out (HCPCS C1713) recovery and EDI 835 remittance underpayment auditing.
Cohort MRF 75th-Pct Value
$2,250,000
Target % of Medicare
14.0% MPFS
Statutory Authority
CMS-ASC-2026-REG (Medicare ASC Wage Index & 45 CFR § 149.610 Good Faith Estimate)
ERISA / Timely-Filing Window
520 Days
1. Commercial Payer TiC MRF Allowed-Amount Benchmarks (API #02)
| CPT / DRG Code | Clinical Procedure Description | Unit | Cohort Claims | MRF 25th Pct | MRF Median (QPA) | MRF 75th Pct |
|---|---|---|---|---|---|---|
| ASC-ORTHO-1 | Outpatient Total Joint & Arthroscopy ASC Facility Fee Carve-Out Schedule (185% of Medicare ASC) | CASE | 280 | $2,850.00 | $5,420.00 | $6,850.00 |
| ASC-IMPL-C1713 | Surgical Anchor/Screw/Plate Implant Pass-Through Reimbursement (HCPCS C1713 Invoice + 15%) | CASE | 390 | $950.00 | $2,150.00 | $2,680.00 |
| ASC-PAIN-63650 | Percutaneous Implantation of Neurostimulator Electrode Array, Epidural (Spinal Cord Stimulator Trial) | CASE | 95 | $3,400.00 | $7,250.00 | $8,950.00 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Premier Multi-Specialty ASC Management LLCTri-County Outpatient Surgical CenterMeridian Orthopedic & Pain Surgery CenterIntegrity Medical Billing & RCM SolutionsHorizon Surgical Partners Holdings