There are a few things you can look for to determine if your billing company is not maximizing your revenue.
Hint 1: Does your current company reconcile every payment versus the contracted rates on a line-by-line basis?
Ask your current company for the line-by-line reconciliation for the past 6 months of billing for your anesthesiology department. If it doesn’t exist or doesn’t show that a significant percentage of the claims were kicked back, then you are being short changed by your payors. Here’s why –
Its impractical to do for most general medical billing companies, but a very important part of anesthesiology billing. Most billing companies reconcile at the macro level, shrug off what appear to be minor discrepancies, and move on. The problem is, healthcare costs tend to go up rapidly. So if payors are paying based on outdated data, they will measurably underpay their contracted obligations.
Your anesthesia billing company should be cross-checking every line item of every claim to ensure that it meets the contracted rate with that specific payor. If there’s a discrepancy, it should be automatically kicked back to the payor to ensure you are receiving the contracted rate.
Hint 2: Does your current company provide customized real-time reporting?
Ask your billing company to provide you reports that show reimbursement rates, expected cash flow for the month, collected vs expected, days in accounts receivable, year-to-date revenue comparisons and provider comparisons. If they don’t have them, that means your billing company isn’t looking at them, which means they aren’t doing their job of maximizing your collections. Accurate reporting and total transparency should be critical for any billing company that you do business with.
Hint 3: Does your billing company brag about low days in accounts receivable?
We see billing companies talk about how they focus on keeping accounts receivable low. Days in accounts receivable is the average time from performing services to receiving payments. Generally speaking, lower is better. It’s obviously important to get paid promptly, but when it comes to anesthesiology billing, an accounts receivable lower than 30 days often indicates that the billing company is just accepting whatever the payors send, and writing off the rest. That’s great for the billing company, but bad for the anesthesia providers.
Maximizing revenue means looking at every line item and ensuring it meets the contracted amount for that service. It means arguing with payors to overcome bogus claims and disputes to force them to meet their obligations. If a payor tries to reject or discount a valid claim, your billing company should be fighting with them over it. That takes time.
Your billing company’s goal should be how to maximize your revenue, not keeping days in accounts receivable below an arbitrary number.
Did you know….The easiest way to determine if your anesthesia practice is collecting less than it should be is to ask Fusion Anesthesia for a no obligation 6-month billing audit. We will show you exactly where you are losing revenue, and how much extra revenue you could be collecting.
It can be “cheaper” to do your own billing. But, you also must add in all the expenses related to doing in-house billing (office space, salaries benefits, management to hire, train, supervise and occasionally fire the employees, the revenue management systems, continual training…etc).
There is also significant risk in anesthesia billing. Any mistakes or problems they create become the problem of the group as a whole. There is significant liability associated not just by the usual employee issues but also by the enormous revenue and HIPAA protected data that flows through your billing operation. You must ensure that your staff is deeply experienced with anesthesia billing and understands every payor quirk.
Also, anesthesia billing is hard. It requires a significant investment in people and processes that are hard to justify if you’re billing for less than a hundred doctors. Sub-optimal investment generally results in lower total collections.
Generally speaking, we find that we can increase the overall revenue of an anesthesia group by 5-15% compared to what their in-house team was collecting. The difference lies in our greater ability to invest in rigorous systems, training, and management. By the time you add up all the increased expenses, increased risk, and lower collections rate…most will see a significant increase in top line when they switch to an anesthesia specific billing company vs in-house billing.
Is there a difference between general medical billing services and anesthesia specific billing services?
Yes, here’s the difference:
General medical billing companies are built to generally maximize revenue across all departments. In general, this works. However, anesthesiology has specific specialties and unique billing procedures. The generalized billing services are not optimizing billing and collections for anesthesiology, which means they are not collecting as much as they should or could be collecting. This equals a loss of revenue. In addition, generalized medical billing services risk regulatory compliance problems and allegations of fraud when coders try to handle the complex work of anesthesia billing without the specialized software or anesthesia coding skills.
Anesthesia specific billing companies give anesthesia billing their 100% focus. They are deeply experienced with every nuance, specialization and specifics of anesthesiology billing. They are expert in every anesthesiology billing situation and the relevant payor quirks. At Fusion Anesthesia, we know how to maximize your revenue by ensuring that we get every detail right. What does this mean for the anesthesiologist? Maximum collections and maximum revenue. We maintain and constantly update our databases to ensure that we format each claim so that it matches exactly how and what each payer requires – including their informal requirements. This customized claim filing by payer significantly speeds up processing.
At Fusion Anesthesia, we assist with compliance concerns and ensure that our doctors are in good standing with government and commercial payors by maintaining all documentation – that way our doctors don’t accidentally over code, and that they comply with national correct coding initiatives.
These kinds of value-added service are very hard to do across multiple specialties.
Did you know…After analyzing hundreds of thousands of claims, Fusion Anesthesia can prove that most anesthesia practices are collecting up to 15% less revenue than they could be.
Most anesthesia billers only collect about 80% of billed revenue, and write off the rest. Fusion Anesthesia fights to collect every penny you are owed – and has an average collection rate between 95%-97%.
Fusion Anesthesia serves a variety of anesthesia providers, from solo providers to groups of 100 +.
Fusion Anesthesia is headquartered in Brookfield, WI. We serve anesthesia providers across the entire United States.