Medical billing service companies know well that anesthesia billing is not the same as any other specialty billing. So they pay extra attention towards billing anesthesia services. Unlike the healthcare providers’ payments that are based on a fee-for-service schedule, anesthesia providers are paid by following a different system consisting of base units, time units, and modifiers.

But it’s certainly not enough! They will have to act more! By following few tips and intelligent billing practices, they can expect huge revenue profits. Anesthesia billing and coding is a mixture of unique and complex specialty requirements which are not found in any other medical specialties. Though many medical billing service companies claim experience and expertise in anesthesia billing, the fact when compared against actual performance reveals a different story.

Here comes some of the tips that medical billing service companies and anesthesia practitioners are advised to follow for feasible revenue payments.

Tips for Medical Billing Service Companies on Anesthesia Billing:

  1. Spotting billing and coding errors
  2. Being precise on report time
  3. Modifiers are important
  4. Append physical status modifiers

Spotting billing and coding errors:

  • Manual errors in medical billing service companies are one of the major reasons for most of the denials and rejections in anesthesia billing.
  • Different types of anesthesia billing have various types of codes which are complicated and often confusing while billing the services.
  • It’s crucial to have clear documentation on the exact type of anesthesia that is being used and ensure that it’s being carried through the billing stage which helps to avoid billing confusions.
  • Anesthesia professionals are experts in performing various services in the operating room. Hence anesthesia billing comprises more than 13,000 procedure codes, which are quite tricky while coding.
  • Additional codes are important and assigning them can result in higher revenue payments for the anesthesia professionals or CRNA.
  • Such add-on codes would be for:
  1. Anesthesia services for patient of extreme age, younger than 1 year and older than 70.
  2. Anesthesia complicated by utilization of total body hypothermia
  3. Anesthesia complicated by utilization of controlled hypertension.
  • Greater coding efficiency is required to get the complex anesthesia coding accurately. Lack of knowledge and a highly skilled workforce may result in greater revenue leakages.
  • Surgical services are provided in a wide variety of settings. So there is less control over the way procedures are monitored by medical billing service companies. Even one minor mistake in assigning codes can lead to an expensive and unmanageable bill.
  • Apart from the coding errors, anesthesia billing errors include:
  1. Waiting to confirm if the patient’s insurance will cover the procedure.
  2. Incorrect recording of start and stop time along with additional or ancillary services.
  3. Not defining the services clearly, not having proper documentation on the type of anesthesia used and carrying that information throughout the billing stage.
  • Insurance authorization services will reduce the chances of claim denials to a greater extent by making sure that the patient is covered for the type of service rendered.

Be Precise on report time:

  • Anesthesia billing mostly depends on the amount of time spent for anesthesia services in the surgical room.
  • Mentioning wrong or improper time will cause major errors and revenue loss.
  • Report timings are often confusing and complex. The time units are defined as the period during which an anesthesia professional is present with the patient.
  • Most of the insurance companies, including Medicare, require exact time reporting to avoid incorrect information. It’s important to ensure that the start and stop times are recorded and billed exactly as outlined in your contract.
  • Medicare calculates anesthesia at 15-minute intervals, and it may differ for other insurance companies.
  • Healthcare Organizations must have adequate number of monitoring systems in the operating room to record the anesthesia time precisely.
  • Professionals and CRNAs are recommended to report only the total anesthesia timings for the sum of the continuous block of anesthesia. Documenting discontinuous time is also required.
  • The actual start and stop time in the appropriate areas and the documentation of discontinuous time in the remark section with legible notes are also essential and crucial.
  • Recent reports have highlighted abnormal billing patterns where anesthesia professionals reported high number of times ending in a multiple of 5 minutes.

Modifiers are important:

  • Modifiers are supposed to be added while assigning the codes to the billing team. Modifiers significantly reveal the physical status, age and the emergency factors that might be added to the procedure codes.
  • The total number of units is multiplied by a conversion value to create the total charge for the procedure. Medical billing service companies must be responsible while billing all of these procedures by having a clear picture and study on it.
  • When the medical billing service companies’ teams are not completely aware of modifiers and their usage, it can result in inappropriate billing and overpayments.
  • Key modifiers explained are:
  1. A: Anesthesia services performed personally by an anesthesiologist or when an anesthetist assists a physician in the care of a single patient.
  2. Y: Medical direction of one certified registered CRNA or an anesthesia professional.
  3. K: Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals
  4. D: Medical supervision by a physician for more than four concurrent anesthesia procedures
  5. X: CRNA service with medical direction by a physician
  6. Z: CRNA service without medical direction by a physician
  7. S: Monitored anesthesia care service [to be billed only by a qualified non-physician anesthetist, anesthesiologist assistant, or physician]
  8. 8: Monitored anesthesia care (MAC) for deep, complex, complicated, or markedly invasive surgical procedure
  9. 9: Monitored anesthesia care for patients who have history of severe cardio-pulmonary condition.

Append physical status modifiers:

  • Physical status modifiers are actually used for reporting the overall physical health of a patient at the time of the patient encounter or procedure. They can have a positive effect on revenue profits or reimbursements.
  1. A normal healthy person (units = 0)
  2. A patient with mild systemic disease (units = 0)
  3. A patient with severe systemic disease (units = 1)
  4. A patient with severe systemic disease that is a constant threat to life (units = 2)
  5. A moribund patient who is not expected to survive without the operation
    (units = 3)
  6. A declared brain-dead patient whose organs are being removed for donor
    purposes (units = 0)
  • All insurance companies except Medicare allow physical status modifiers to receive additional total units of anesthesia reported for the patients with higher risk factors of chronic conditions.

 

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