While external audits are an extremely effective way to evaluate how your anesthesia billing service is performing, an audit can be costly and time consuming. While the results may provide the best insight to your vendor’s performance, we’ve put together a list of questions to help anesthesia groups determine if their current anesthesia billing company is up to par and collecting the money your practice is due in lieu of an audit.

1. Ask your current anesthesia billing company for net collection percentage by payor. 

The formula for determining your net collection percentage is quite simple: dollars that were collected against your payor contracted amount (expected). Your payor contracted rates should be loaded into the billing system for easy comparison. Net collection percentage is a crucial metric for your practice to have and is directly related to your billing company’s performance. Fusion Anesthesia clients can view their net collection percentage at any given time via our CogitoAnalytics platform. This proprietary data and analytic tool provides our clients with near real-time data and reporting.

If you have no idea what your current net collection percentage is, ask your current anesthesia billing service for that metric over a period of time and the formula they use to calculate. Be mindful of the time it takes to receive this information and whether the data and reporting they provide supports their answer.

2. Are all payments reviewed for accuracy? 

This question relates directly to the net collection percentage discussed above. Your payor contracted rates should be loaded into your vendor’s billing system. Any payment received that does not adhere to your contract should generate an alert. Payors continue to underpay claims and most underpayments should be appealed to ensure the payor is meeting their contractual obligations. It’s easy to collect the initial 80% of billed charges but the remaining 20%, those are the labor intensive hard to collect dollars that require rigorous follow-up and that 20% can have a huge impact on your practice’s bottom line.

3. Does your billing company provide payor contract negotiation support? 

Your billing vendor should play a key role in this service. The No Surprises Act has created endless roadblocks in the negotiation process; however, your vendor should overcome those roadblocks and initiate negotiations on your group’s behalf. Contract expiration dates should be loaded into a system and allow for ample time to initiate the negotiation process. Contracts should be reviewed, and your billing vendor should make recommendations on increases using the American Society of Anesthesiology Annual Conversion Factor Survey Results as well as other data. Your billing vendor should supply you with a matrix of your payor contracts including the current conversion factor, amounts paid for flat fees and the contract expiration as well as their plan and recommendation for initiating negotiations.

4. What type of reports do you receive? 

Most anesthesia billing companies provide a set of month-end reports and most now provide some type of dashboard. The problem with month-end reports is the vendor is likely limited in the types of system generated reports available as well as how that data is presented, especially if they are using a multi-specialty billing system. Data is the new currency, and everyone expects immediate answers and information at their fingertips.

Ask your current vendor if they can customize their reports or dashboards to suit your needs. Asking for the raw data that supports the reports is also a must have. Providing patient and claim level detail demonstrates the transparency between your two entities.

5. Is there a reconciliation process to ensure no charges are missed? 

While most facilities have transitioned to some type of Electronic Health Record (EHR), electronic transmission of anesthesia records to your vendor is not always foolproof. It is imperative that your billing vendor work with each of your facility’s IT departments to ensure all anesthetizing locations are captured including often missed NORA sites. For facilities on paper, cases received must be compared to the daily surgical schedule to ensure all cases are captured including any add-ons. Ask your current anesthesia vendor what their reconciliation process is for your practice. Do they have an alert system in place if cases are not received as scheduled?

If you would like to hear more about Fusion Anesthesia Solutions or you’d like our help in evaluating your current vendor, please email us at sales@fusionanesthesia.com. We would love to hear from you and share our success stories.