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Anesthesia Revenue Cycle Management: Improve Anesthesia RCM Processes

Finance and health are two complex fields on their own. And we know you’re busy. Your main focus should be on your practice and patients. However, having a basic understanding and knowing the tricks-of-the-trade when it comes to anesthesia revenue cycle management (RCM) will yield better results for your practice. 

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Revenue cycle management and its associated processes can feel overwhelming at first – but you should have a general understanding of how it all works. You don’t have to memorize obscure codes and fully comprehend every nuanced detail of the complex reimbursement process, just follow these steps to improve your anesthesia revenue cycle management processes:

1. Do more than just ask

Don’t just ask for information, require insights. Many anesthesiologists don’t take the time to deep dive into anesthesia RCM – especially if they have a billing company that they’re working with. They just trust the “experts” are doing a good job.

Here are two things you can do to be more proactive:

  • Conduct reviews
  • Ask for reports (regularly and randomly)

Be more proactive in your revenue system. After all, that’s your money.

This will give you more insight into which KPIs are important, which ones yield the best results, and which ones you should be actively trying to improve.

Want to know which KPIs you should be focusing on?

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Anesthesia Group Profitability: The 5 Metrics to Focus On

We are not talking about long excruciating audits, although sometimes they are needed. Just pick a particular KPI and have your billing company explain this month’s results compared to other months.

This is also a good way to track accounts receivable issues. Underpayments consistently happen and you want to pay special attention to them. Many agents will just overlook them, some don’t have the bandwidth for better reconciliation, and some just hope you don’t notice. You will be surprised how underpayments prevent you from receiving the maximum return for your services.

Many anesthesia billing companies don’t collect complete payment on every single claim, which can ultimately decrease your take-home by 5-15%.

2. Identify most-billed codes

Seeing patterns in your payments is a great way to understand your leverage and focus. By digging into the metrics to see which codes you bill most often, you will be able to uncover trends, see if there are ways to improve these metrics and if there are any codes that are regularly overlooked.

You do not have to memorize every code. What’s important is that you spend a little time understanding these codes and how they impact your practice. By looking into the 5 or 10 codes that you bill most often, you can see where about 70 percent of your overall revenue is coming from.

Addressing top codes can help prevent recurring problems that greatly impact your bottom line.

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3. Create a payor matrix

Payors have individual contracts with every single anesthesiologist, which each have specific details for reimbursement amounts and payment deadlines. This results in thousands of data points and potential mistakes for payors trying to meet contracts and is why payors consistently underpay. This may not be a top concern for other specialists, but the least you can do is track this information for your practice.

Creating a payor matrix shouldn’t be too elaborate. Keep it simple, clean, and include the essentials of every contract you have.

Some of these essentials may include:

  • Default fee schedules
  • Effective and terms dates
  • Notice periods

Be sure you are covering all of the components of your day-to-day operations. Keep the matrix short, simple, and updated to any regulation and price changes.

Maintaining a payor fee matrix is the first step to ensuring you receive complete payments – but it can be a lot of work to gather this data and keep it up to date. Instead, you should find a billing partner that has the tools to compile and maintain this information for you.

If this is something that you think would be beneficial to your practice, contact us to see how we can help.

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4. Observe changes in payments

Most payors follow Medicare’s lead in terms of payment amounts, but not all. Thanks to the internet, you can instantly verify all of these changes. Make sure your contracts with all payors are up to date when payment amounts increase, or you could miss out on potential revenue. In particular, you should note when any changes are proposed to your top 10 billing codes as this will have a direct effect on your reimbursement procedures and overall revenue.

Make sure you are aware of any relevant regulation changes in billings, paying guidelines, and fees.

5. Ensure compliance

Increasing your revenue doesn’t only mean increasing income – it also includes avoiding fines that can result from not meeting compliance or missing components for required reporting programs. Familiarize yourself with federal and state rules, pay due diligence and taxes, and double-check that your billing company is updating its processes as needed. Avoiding delays in payments for compliance will also help you maximize revenue.

6. Work with the right people

We can’t stress enough how important this step is. Working with the right people is a key contributor to business success. Whether you complete billing in-house or work with an outside partner, this team is ultimately responsible for handling and optimizing your anesthesia revenue cycle management processes.

Increasing revenue should be your billing team’s top priority.

anesthesia revenue cycle management - anesthesia RCM - team

If you are going to develop a team of your own, you will need to train them – especially for anesthesia RCM. Anesthesia billing is unlike other specialties, so even if they come from another biller with lots of experience it won’t necessarily apply to the nuances of anesthesiology. If you opt to work with a third-party to outsource your billables, make sure they are vetted anesthesia veterans because of this specialties’ financial, technical, and legal complexities.

Before partnering with any RCM vendor, make sure you know their core values and philosophies and check that they have the best technology, people, and processes to make revenue management smooth and error-free.

Improve Your Anesthesia Revenue Cycle Management

There are many ways to improve your anesthesia revenue cycle management processes and just being mindful of the basics can go a long way. However, focusing too much on improving your revenue can take a toll on other aspects of your practice. Find someone who has the expertise you need and the processes already in place to handle your anesthesia revenue cycle management.

We recommend getting help from anesthesia RCM experts, like Fusion Anesthesia.

Get Help from Experts

Fusion Anesthesia has been doing billing and revenue cycle management just for anesthesiologists for the last 45 years. We have seen every possible anesthesia billing situation and understand all the complicated details. Since we work with over 400 anesthesiologists nation-wide, we have comprehensive insight into the billing market and can pass that expertise onto your practice. Most importantly, we have the resources required to reconcile and collect every penny owed, on every claim, every time. By completing our anesthesia RCM processes in this way, we are able to increase your practice’s revenue by 5-15% and can provide you with dashboard reports so you can see how your revenue is flowing in real-time.

We use experts, automation, and technology, to ensure you receive
your full compensation, every time.

Want to know how we can optimize your anesthesia revenue cycle management processes to increase revenue?

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