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The scope of anesthesia is different from other medical specialties, and it complicates the medical billing process. Exceptional standards of anesthesia are the reason behind intricacy.
Anesthesiologists extend their services in three situations such as pre-surgery, during surgery, and post-surgery. Most patients may require anesthesia during all three situations. Yet it is specific to individuals, their medical condition, and the required treatment. The dosage can vary from patient to patient.
A single anesthesiologist deals with various patients daily and renders required services. Their task is not over with meeting the patient’s requirements. They must take care of administrative tasks and achieve enough revenue.
Handling revenue cycle management is not easy, and healthcare providers must face various challenges to meet the desired results.
In this blog, we will understand common anesthesia billing challenges that prevent healthcare providers from achieving a robust bottom line. We will also go through things healthcare providers can do to improve their medical billing process.
Common Pain Points of Anesthesia Billing
Obstacles in Medical Billing
Anesthesia medical billing is unlike billing for any other specialty. This is because charge capture in anesthesia is defined by the level of surgical difficulty. The billing process includes the category of the procedure, time taken to complete the procedure, outlining surgical direction and supervision, accurate coding and adherence to compliance standards.
The three important factors of anesthesia billing are:
- Difficulty in Performing Surgical Procedures
- Duration of a Procedure
- Variable Factors Like the Patient’s Health
Anesthesia billing is done with a basic formula and healthcare providers apply this formula to capture charges from every patient. The formula includes the above-mentioned factors, and they are named base units, time units and modifying units.
Simply putting these in a formula can help healthcare providers in receiving revenue. Adding the three factors and then multiplying them with the conversion factor results in an anesthesia charge. (Base Units + Time Units + Modifying Units) × Conversion Factor = Anesthesia Revenue
Let’s define these terms:
Base Unit – Every anesthesia procedure has a base unit value. This unit grows with the difficulty of the procedure
Time Unit – This indicates the total time spent (usually within minutes) on a procedure. One time unit is 15 minutes
Modifying Unit – This includes conditions such as emergencies or alterations in the patient’s condition. It prevents duplicate billing
Conversion Factor – It is the allocated cost to each unit, and it may vary based on the location of the healthcare practice
Concerns Related to Documentation
Anesthesia is an elaborative process. As discussed above, during surgery anesthesia can be used thrice based on the patient’s treatment. All these details must be recorded and documented to carry out medical billing accurately.
In normal situations, an anesthesia provider has to document phases of treatment such as:
- Pre-operative Assessment
- Anesthesia During Surgery
- Post-surgical Care
To ensure the accuracy of claims, healthcare providers must ensure correct documentation of these details. Accurate information leads to streamlined coding and claim filing. Errors and missing details can lead to claim denials and revenue leakage.
If a procedure gets canceled before surgery, that should be reflected in the evaluation and management code. The claim must include information such as the reason behind cancellation (It can be a technical issue).
If a procedure gets canceled after surgery has started, it must be reflected with the appropriate modifier and include time. There may be chances that such modifiers are not accepted by insurance companies. In that case, such procedures must be recorded with the right anesthesia codes according to base units and total recorded time. The reason behind the cancellation must be stated in documented data.
Need to Attain Prior Authorization
In anesthesia medical billing, healthcare providers must attain pre-authorization. This must be done before rendering the services and starting the treatment procedure starts. Prior authorization is basically the approval from the insurance company that a patient is eligible to receive care based on the insurance policy. In case the healthcare providers neglect this step, they have to go through intricacies such as denials and loss of revenue.
This is an essential part of anesthesia billing and healthcare providers must take extra measures to ensure obtaining prior authorization.
Complicated Coding Requirements
When we are talking about anesthesia billing challenges, we cannot miss coding complications. Errors in coding can hamper the revenue cycle management of an anesthesia practice. This is not a good sign for healthcare providers.
That is why healthcare providers must improve their coding process and yield clean claims. For this, they have to focus on more than just codes but also other steps like recording and documenting accurate patient information.
On the other hand, they must perform coding with precision. There are around 13000 anesthesia codes, and it is not possible for a healthcare provider to remember all of them.
Healthcare providers must take care of certain things while coding and they are:
- Identify Accurate CPT Codes
- Ensure Accurate ICD–10 Codes
- Prioritize Medical Billing Based on Time
- Code Accurately for Multiple Procedures on a Single Patient
Incorporation of Modifiers
There is a wide usage of modifiers in anesthesia medical billing. This makes being familiar with modifiers important for healthcare providers. The role of modifiers is different from procedure codes. Modifiers define various factors such as the medical status of the patient or emergencies. All in all, modifiers are meant to give additional information about a surgical procedure. They are written along with CPT codes to give a clear idea about anesthesia procedures to insurance providers.
A failure to add inaccurate modifiers can lead claims to denials and hamper the financial stability of healthcare providers. Healthcare providers must pay extra attention to the usage of modifiers to secure their revenue.
There are two types of modifiers for anesthesia, and they are pricing modifiers and informational modifiers. Being able to distinguish these two types and using the correct modifier is a skill.
Pricing Modifiers are from AA to QZ, and they are added to provide information such as the number of healthcare providers, or anesthesiologists involved in a surgery or a procedure.
For Illustration,
AA modifier is added when an anesthesiologist renders services personally, and AD is written when services are rendered under the provision.
Informational modifiers or statistical modifiers signify the medical status of the patient. They are utilized in addition to pricing modifiers. These modifiers affect revenue, and this makes them important in the medical coding process.
Dynamic Billing Standards
Another major challenge in anesthesia billing is the ever-changing medical billing regulations and the compulsion to meet them all. Compliance standards define the reputation of healthcare practices and signify the level of skill in performing all steps.
When it comes to coding, fulfilling coding guidelines is essential to ensure a clean claims rate, otherwise rules such as HIPAA, and regulations of Medicaid and Medicare are necessary to protect patient data from misuse.
Healthcare providers must follow all state laws and regulations. It is crucial for healthcare providers to keep up with dynamic rules and regulations to ensure a smooth workflow.
Denial Management and Follow-up
Denial management is equally important in a medical billing process as any other step. Healthcare providers cannot deny the emergence of claim denials until they focus on improving their denial management.
Denial management has two vital functions. The first is to identify the reason behind denied claims, rectify issues, refile the claims and recover the lost revenue. Second is being proactive and forecasting intricacies to avoid denials in the first place.
Following up with claim processing and keeping a close eye on the last step of medical billing is also a part of denial management. Healthcare providers cannot neglect the need for efficient denial management, and they must take steps to implement it.
Face the Challenges with Professionals: Outsource Anesthesia Billing
Dealing with anesthesia medical billing is a hassle for healthcare providers. Ensuring administrative efficiency and quality patient care can be a lot of work. There are adverse effects of not handling challenges properly and healthcare providers can lose reimbursement.
All this can be stressful leading to burnout and exhaustion. Receiving adequate collections is not just about challenges, it is also about streamlining revenue cycle management and improving the workflow.
Making healthcare profitable requires assistance and outsourcing is the ideal choice to master the level of efficiency and accuracy.
If you are an anesthesiologist struggling with medical billing, choose Eminence RCM.
Eminence RCM meets the unique needs of healthcare providers and provides solutions to handle complex medical billing situations. We are proficient in understanding issues and offer efficient medical billing. Our team of billers and coders ensures comprehensive accuracy and efficiency in every administrative function.
We use advanced tools to eliminate human errors and avoid claim submission delays. With our services, you can maximize revenue and uplift operational flow.
So, choose Eminence RCM and breakthrough billing challenges with ease!
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