Anesthesiology is a highly specialized and complex service with an equally complex anesthesia billing formula. Some many rules and guidelines are specific to anesthesia care and the anesthesia billing formula used to determine reimbursement is unique to anesthesia.
Here are a few of the benefits of outsourcing your hospital’s anesthesia revenue cycle management:
Electronic Health Records (EHRs): Great for charting not for anesthesia billing
Most hospitals and hospital owned Ambulatory Surgery Centers are using some type of (EHR). While those EHRs are great for capturing patient information and charting, there are many deficiencies when it comes to anesthesia billing. 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 billers and coders 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.
Anesthesia Modifiers
In addition, it is crucial to reimbursement to properly use anesthesia modifiers. Some modifiers affect anesthesia billing reimbursements 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 (certified registered nurse anesthetists) and medical supervision. These details play into the complexity of the anesthesia billing process. 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 some private payers do, and these reimbursable charges are often missed.
Non-Operating Room Anesthesia Procedures (NORA)
Non-operating room Anesthesia Procedures is another area that revenue leakage occurs within anesthesia billing. 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. Outsourcing to an anesthesia billing company that is anesthesia specific and well established and experienced can prevent this revenue leakage.
Case Reconciliation
Most hospitals do not have a process in place to ensure every single anesthesia services is captured and billed. Some anesthesia billing companies, such as Fusion Anesthesia Solutions, works with their clients to obtain a final surgical schedule for every anesthetizing location which is used as a foundation for comparison against cases received.
Reporting
EHRs are often incapable of allowing the extraction of specific anesthesia billing data such as volume by procedure category i.e. Surgical/OB/Cardiac/Acute Pain, etc. During information discovery with potential hospital clients, most EHRs cannot provide accurate revenue information for anesthesia professional billing.
Outsourcing the anesthesia revenue cycle management to vendor specializing in anesthesia will undoubtedly increase revenue. Many hospital leaders fear outsourcing this service will result in a lack of oversight of the revenue cycle, however, in our experience it improves it. Through technology and reporting, some anesthesia billing companies such as Fusion Anesthesia Solutions can provide hospital partners with data on anesthesia services and revenue that they never had access to before.
