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CRNA Billing: Submitting a Clean Claim and Reconciliation

CRNA billing is not simple. It’s a tedious process that requires the right people, the right systems, and the right expertise to do it right. At the core of the process is a correctly coded claim and without it, there’s no way you can maximize revenue. Here’s how it should be done.

The Claim and Reconciliation Process

The best practices for CRNA billing process are as follows:

CRNA billing - billing for CRNA services - process
  1. Anesthesia services are performed.
  2. Notes are submitted (handwritten, transcribed, or electronically through an EHR) to the billing company.
  3. Certified coders work through the notes to translate them into clean claims with codes based on the surgical or pain procedures performed.
  4. Coded claims are submitted to insurance companies for payment.
  5. Claims are tracked and monitored to ensure that payment is received within contracted time frames. Line items are compared to a database of client contracts to ensure payment matches the contracted amount.
  6. Some payment is received. Sometimes this payment is the complete contracted amount. If so, this process stops here. Unfortunately, payors regularly underpay compared to their contracted amounts, therefore, extensive follow-up is required.
  7. Reconciliation begins. Every line item is compared against the contracts in the database. Billing companies must kick-back and resubmit paperwork again and again for denied and underpaid claims until it is paid in full.

Step seven is where you really want to take note of what your current CRNA billing provider is doing, simply because they probably aren’t doing it. Most billing organizations simply end their process at step six. Whatever amount is collected at this point is all you will receive; they won’t take the time required to follow up until you’re paid the fully contracted amount.

Without a rigorous reconciliation process, you could be missing out on 5-15% of earned revenue.

The Critical Components

CRNA billing requires more than just a comprehensive claim and reconciliation process. You need to make sure you have the right resources every step of the way.

The Right Expertise

Billing for anesthesia services is harder than other specialties. You must consider codes, base/modifying/time units, conversion factors, and flat fees. Using a general biller will likely have you leaving money on the table. Their generalized systems can’t take into account the outlying factors and their bandwidth makes them unable (or unwilling) to complete the necessary reconciliation steps.

Our billing services are only for anesthesia professionals.

The Right People

You want to make sure your CRNA billing provider has fully-trained and AAPC-certified coding specialists who are experts in anesthesia billing. Just like an experienced CRNA, the best CRNA billing services are specialized and have years focused on just one specialty.

CRNA billing - billing for CRNA services - people

The Right Systems

Just like you need to have specialized people, you also need to have specialized systems to handle the nuances of CRNA billing. General billing software just won’t get you maximum collections. These systems have been optimized to collect across all specialties. While there are some commonalities in billing, there are also some major differences that need to be considered.

We use a hybrid of off-the-shelf billing software with custom-developed reconciliation and reporting software to help us track every single line item and contract.

Increase Revenue with the CRNA Billing Company

The entire claim and reconciliation processes are central to increasing anesthesia group revenue. By optimizing these processes and collecting every penny of what you are owed, you can increase take home by 5-15%.

Want to see how much you should be taking home? Sign up for a no-obligation analysis of your last 6-months of anesthesia billing to see where your current billing company missed out on potential revenue.

Or if you want to know more about the secrets of CRNA billing, download our eBook: Anesthesia Billing for CRNAs: How to Increase Group Revenue.

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Download our Free eBook: Transparency in Anesthesiology Billing: Everything Your Billing Company Doesn’t Want You to Know

Interested in lowering your costs? Let’s talk.

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Anesthesia jokes are funny - getting underpaid isn′t.

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