Anesthesia billing is more than just coding and submitting claims, collecting whatever money comes in, and calling it a day. It takes detail-oriented coding specialists, anesthesia-specific expertise, precise reconciliation processes, and extensive follow up.
It’s Important to Understand How the Sausage Gets Made.
No one really wants to dig into the minutiae of billing. It’s tedious. But it’s critical. Every dollar an anesthesiologist or CRNA takes home has to be billed and collected first. This is obviously the job of their medical billing services. However, it’s important that groups understand the billing and collections process at a high level to ensure that they can ask the right questions and make sure that they are getting what they are paying for. Medical billing services aren’t cheap, but the best anesthesia billing services can substantially (and legitimately) increase practice revenue.
Lower Fees Don’t Translate to More Money for the Doctors
Almost all medical billing services are paid through a percentage of revenue, not hourly. But their workers are paid hourly. And, like anything in life, the 80/20 rule applies. 80% of the revenue comes in with 20% of the effort.
This leaves medical billing services with a big incentive to just collect the easy money and move on. And guess what? That’s exactly what most of them do. Especially the discount services that collect a smaller portion of revenue. They don’t really have the margin to do anything else. The problem is, by saving 1 or 2 revenue percentage points on fees, their clients are typically losing 5-15% of their top-line revenue. That translates to a pretty expensive “discount”.
Most billing companies collect the easy 80-85% of revenue and just leave the rest.
The best billing services charge a high enough percentage of revenue that they can (and will) go after the harder-to-collect dollars. Of course, it’s not enough to just charge more. The best billing services need to have the processes in place to actually collect that revenue for their clients.
- Anesthesiology services are performed.
- The anesthesiologist submits their notes (handwritten, transcribed, or electronically through an EHR) to their billing company.
- Certified coders work through the notes to code and submit clean claims based on the surgical and/or pain procedures performed.
- Claims are submitted to insurance companies for payment.
- Claims are tracked and monitored ensuring that payment is received within contracted time-frames. Each line item is monitored and compared to a database of client contracts to ensure payment meets the agreed-upon amount.
- Some payment is received. Sometimes the complete payment is received on the first claim submission. Unfortunately, payers consistently underpay compared to their contracted amount. This industry-wide issue is what makes extensive follow-up and reconciliation necessary.
- Follow-up and reconciliation begin. Every line item is compared with the relevant contracts for each specific anesthesiologist. Billing companies must fight against denied and underpaid claims, resubmitting paperwork again and again until the claim is paid in full based on the established contract.
Too many medical billing services skimp on steps 5 and 7.
The Need for Specialized Expertise
Anesthesia billing is hard. Harder than most medical billing. That’s why anesthesiologists can’t utilize a general billing service without leaving potential revenue on the table.
The billing process for anesthesiology is significantly different than the billing processes for other specialties. Standard physician billing processes and software simply don’t work for anesthesia. Just like an experienced anesthesiologist, the best anesthesia billing services are specialized and have focused for years on just one specialty. In order to successfully collect the maximum appropriate amount on every claim, billing companies need specialized people and systems that take into account the specifics of anesthesiology billing.
The best anesthesia billing services use AAPC-certified coding specialists with expertise in anesthesiology coupled with software that supports their work. In order to effectively collect, billing companies should be able to not only ensure that every claim is paid but be able to drill down to the specific line items that are left underpaid using advanced reconciliation software.
Complete Anesthesia Practice Services
The best anesthesia billing services are not siloed from other aspects of the practice. Billing is just one part of running a practice. Therefore, anesthesia billing companies provide comprehensive services to help improve practice optimization and efficiency.
Accurate reporting and total transparency are an important deliverable for any billing company. Whether practices choose to look at the data is completely their choice, but it should be readily available so there is complete oversight into everything happening within the business. Reports should include:
- Reimbursement rates
- Expected cash flow for the month
- Collected vs expected
- Days in accounts receivable
- Year-to-date revenue comparisons
- Provider comparisons
Real-time transparent reports provide insights into exactly how the practice is doing.
Value Added Services
The best billing services offer additional value-added practice management and other back-office support since most anesthesiology practices have limited non-clinical staff. Things like:
- Contract negotiation
- Compliance and quality reporting
- Accounting, tax, and payroll
- Bookkeeping and bill paying
- Scheduling and efficiency analysis
- Credentialing support
How to Find the Best Anesthesia Billing Services
Understanding what to look for in an anesthesia billing company is hard. Most billing companies claim to provide all the services you need.
Want to know what to look for in evaluating your current or a prospective billing company?
Download the eBook Transparency in Anesthesiology Billing: Everything Your Billing Company Doesn’t Want You to Know.