Many hospitals use the same billing process for all their specialties. However, anesthesia is the most complex of any specialty to bill. It is extremely tedious, and the billers must know all the intricacies and specialties in order to bill for anesthesia properly. For example, there are a large number of documents that must be reviewed to accurately code and bill. There is also a special formula used to bill for anesthesia (Base Units + Time Units + Modifiers) x Conversion Factor.
Typically, when hospitals use the normal generic billing process across all of their specialties, they end up losing revenue in their anesthesia services due to improper billing. Hospitals can actually increase their revenue and positively impact their bottom like by outsourcing their anesthesia billing to an anesthesia specific billing company.
Here are a few examples of areas that will negatively affect a hospital’s bottom line by using a generic medical billing system for their anesthesia billing:
Electronic Health Records for Anesthesia Billing:
Most hospitals are now using some type of Electronic Health Record (EHR). While those EHRs are great for capturing patient information and charting, there are many deficiencies when it comes to billing for anesthesia services. There are often disconnects between anesthesia clinicians on where services such as blocks should be documented and whether the hospital billing staff is receiving those charges to bill. Seasoned anesthesia coders and billers will know what procedures have ancillary anesthesia services to be billed whether or not the service has been documented (i.e. common surgeries that require post-operative pain management or vascular line placements for additional monitoring during complex surgeries.
Concurrency Analysis:
Concurrency analysis is another area of concern for hospitals. Concurrency is defined as the maximum number of procedures that the anesthesiologist is medically directing within the context of a single procedure and other procedures overlap each other. Unless you are utilizing an anesthesia specific billing platform that is designed to identify errors, such as concurrency, you may create compliance issues for your hospital. Once all charges and times are entered, an anesthesia specific billing platform will run a concurrency analysis to identify overlapping times, invalid times, inconsistent or suspect coding, and modifiers, etc.
Proper Reimbursements for Anesthesia Modifiers:
In addition, it is crucial to reimbursement to properly use anesthesia modifiers. Some modifiers affect reimbursement that denote whether the case was performed solo by an anesthesiologist (AA) or if the case involved medical direction (QK) as well as other modifiers for CRNAs and medical supervision. Physical Status modifiers are used to distinguish between various levels of complexity of the anesthesia service provided, i.e., P1 for a normal healthy patient. While Medicare does not recognize or pay additional units for Physical Status many private payers do, and these reimbursable charges are often missed.
Non-Operating Room Anesthesia Procedures:
Non-Operating Room Anesthesia procedures (NORA) is another area that we find revenue leakage. These are procedures such as intubations and heart catheterizations performed outside of the OR. These procedures often must be manually extracted from the hospital EHR and most hospitals do not have a process in place to capture these procedures nor has the staff been trained to recognize this is an issue.
Anesthesia revenue cycle requires coders certified in anesthesia and pain management (CANPC) as well as medical billers with deep anesthesia billing expertise to ensure every anesthesia service is accurately and compliantly coded and billed to the highest level of specificity to capture maximum reimbursement.
