By: Jeanette Mini, Vice President of Business Development
The financial turmoil continues for hospitals and health systems as they struggle to find stability amid the ongoing Covid-19 pandemic. In 2020, 47 hospitals closed or filed bankruptcy; some were already facing hardship and the pandemic accelerated action. The American Hospital Association estimates that hospital revenue in 2021 could be down anywhere from $53 billion to $122 billion from pre-pandemic levels. Add in supply chain issues and labor shortages forcing premium pay for clinical staff, hospitals will need to cut costs anywhere they can while maximizing revenue streams.
Queue Fusion Anesthesia Solutions
The revenue generated by hospital anesthesiology departments is often overlooked. Most hospitals and health systems bill for anesthesia services internally and, in our experience, hospital systems are simply not designed to capture and bill every specialty with outlier requirements such as anesthesiology. Fusion can help. Fusion Anesthesia Solutions has provided revenue cycle and practice management for hospitals and private anesthesia practices for over 47 years. Our hospital partners typically experience a 5% to 15% increase in anesthesia revenue when switching to Fusion.
Specialty Services Require Specialized Coding and Billing
To properly and accurately bill for anesthesia services, one must know and adhere to the rules and guidelines that are specific to anesthesia care. The formula used to determine payment for anesthesia is quite complex and unique to anesthesia.
We’ve performed many audits for hospitals over the years and virtually every report points to issues with coding, both under coding and over coding. Under coding anesthesia procedures can translate to a significant loss of revenue, especially when you amortize that over an extended period of time. In addition, both over coding and under coding put your hospital at risk for regulatory compliance issues.
In addition, it is crucial to reimbursement to properly use anesthesia modifiers. There are modifiers that affect reimbursement that denote whether the case was performed solo by an anesthesiologist (AA) or if the case involved medical direction (QK) and other modifiers for CRNAs and medical supervision. Physical Status modifiers are used to distinguish between various levels of complexity of the anesthesia service provided, i.e. P1 for a normal healthy patient. While Medicare does not recognize or pay additional units for Physical Status many private payers do.
Why an Anesthesia Specific Billing Platform is Key
While most hospitals have moved to EHRs we have found that the anesthesia modules of those EHRs do a great job for capturing patient information and charting, but there’s often a disconnect between anesthesia clinicians on where services like blocks should be documented and whether or not the billing staff actually gets those services to bill. Seasoned anesthesia coders and billers will know what procedures have ancillary anesthesia services to be billed, whether or not they see them documentation (i.e. common surgeries that require post-operative pain management or vascular line placements for additional monitoring during complex surgeries).
Concurrency analysis is another area of concern for hospitals. Concurrency is defined with regard to the maximum number of procedures that the anesthesiologist is medically directing within the context of a single procedure and other procedures overlap each other. We utilize an anesthesia specific billing platform that is designed to identify errors, such as concurrency, prior to claims submission. Once all charges and times are entered, our anesthesia billing software will run a concurrency report to identify overlapping times, invalid times. Inconsistent or suspect coding, and modifiers, etc.
Non-Operating Room Anesthesia (NORA) is another area that we find revenue leakage. These are procedures such as intubations and heart catheterizations performed outside of the OR. These procedures often have to be manually extracted from the hospital EHR and most hospitals do not have a process in place to capture these procedures nor do they have staff qualified to recognize this is an issue.
Reconciling Charges and Payments
Hospitals do not have separate anesthesia contracts; language pertaining to anesthesia payment is often buried in the hospital’s overall contract with a payer. Fusion works with our hospital partners to develop a payment level matrix that identifies the current anesthesia conversion factor by payer as well as a flat fee schedule (procedures such as labor epidurals). We provide data to assist you in negotiating regular fair market value increases for anesthesia services. Our anesthesia specific billing platform holds an expected payment for each service by payer and we reconcile every single payment against the expected to ensure your hospital secures every dollar it’s due.
Analytics and Utilization
Data is no longer a buzzword, it’s essential for a hospital to have actionable data that helps users identify everything from payer mix changes to OR utilization. Fusion has developed a proprietary tool, CogitoAnalytics, to help our hospital partners bridge the gap between their finance teams and anesthesia clinicians. CogitoAnalytics allows us to assign roles based on users so you can designate access to financial reporting to your finance team and access to procedural information to a clinician. CogitoAnalytics syncs daily with our billing platform to provide up-to-the-minute data and 100% transparency into the billing process.
CogitoAnalytics also provides OR Utilization data to assist in identifying areas that may be overstaffed or issues with room turn over.
Annual Documentation Reviews
Hospital EHRs have done a great job of prompting clinicians to complete each box in order to close out an anesthesia record and send the charge onto billing. However, that doesn’t stop certain anesthesia providers from going through the prompts to complete the process leaving many potential charges in limbo. Fusion has developed a communication/feedback loop with anesthesia providers so if there are any questions that require an answer in order to bill the charge they are handled immediately. We track those communications and use those as a foundation for our annual provider documentation training. We use this time to provide a refresher on the coding and billing process, identify ongoing issues and notify anesthesia providers of any industry changes that have occurred that could potentially affect reimbursement. When Covid hit, we quickly moved to a web-based session which seems to be the preference for most providers.
Speak with your anesthesia providers, survey them on whether or not they feel the hospital is doing a stellar job billing for anesthesia – I bet you’ll be surprised at their answers. Partnering with Fusion Anesthesia Solutions ensures your anesthesia billing is done correctly and compliantly and will free up your staff to focus on other areas of the revenue cycle. Most importantly, we will benchmark your existing anesthesia revenue metrics and track our improvement to your bottom line. Healthcare workers must focus on patient care across all specialties, let the anesthesia billing experts manage the coding and billing nuances for you.
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