Whether you are an independent anesthesiologist group or in charge of hospital revenue, picking the right billing company is critical to maximizing revenue. While there are many anesthesia billing companies out there, not all are created equal.
We have separated this article into two parts – The first is How to Pick the Right Anesthesia Billing Company for Independent Anesthesiologist Groups. The second part is How to Pick the Right Anesthesia Billing Company for Hospital Anesthesiology Departments (scroll down to find).
Part 1: How to Pick the Right Anesthesia Billing Company: Independent Anesthesiologist Groups
The first component to consider when selecting the right billing company is their specific expertise with anesthesia billing. Anesthesia cannot be billed like other specialties. Between base units, time units, modifying units, and all the various procedure codes, there is a lot to take into consideration. The best billing company for you will have specific expertise in your specialty and thus be able to appropriately maximize billing for any given procedure.
Meticulous Reconciliation and Revenue Cycle Management
In a perfect world, anesthesia claims would be submitted and paid in full on the very first try. Unfortunately, this is not the standard for most anesthesia cases.
In order to collect everything you are owed, your anesthesia billing company should be completing a meticulous reconciliation process for every line item of every claim as part of their revenue cycle management service offerings. This entails:
- Collecting anesthesia notes on the services performed.
- Coding clean claims based on the notes for the surgical and/or pain procedure performed.
- Submitting claims to payors for payment.
- Tracking claims to ensure that correct payment is received within contracted time-frames. Each individual line item should be monitored and compared to the database of contracted rates to ensure that payment is received in the correct amount.
- If payment is received but doesn’t match the contracted amount (which happens with stunning frequency), your anesthesia billing company should resubmit the paperwork over and over again until the bill is paid in full.
If your billing company doesn’t follow every step, then you could be leaving your hard-earned money on the table. This is particularly important to remember as you investigate “discount” billers. While your service costs may seem lower as a percent of revenue, your collected revenue might be 5-15 percent lower than what a more expert company would collect—in other words, saving money on service fees will actually lose you money in the long run.
If your anesthesia billing company doesn’t meticulously track and follow up on every payment, then you could be losing money.
Comprehensive Practice Management Services
Billing and revenue cycle management shouldn’t be completely separate from other aspects of your practice. When looking for anesthesia billing companies, look for ones that also provide comprehensive practice management services. With these additional services, you can focus on serving your patients rather than worrying about administrative work:
- Contract negotiation: Improve your insurance, hospital, and stipend contract negotiations with in-depth data that give you a competitive edge at the negotiating table.
- Compliance and quality reporting: Continually monitor all necessary compliance requirements, and develop and implement your quality reporting strategy based on your practice’s unique parameters.
- Accounting, tax, and payroll: Payroll management, tax preparation, and accounting services range from budgeting to benefit plan administration.
- Bookkeeping and bill paying: Let someone else manage all of the financial and paperwork hassles of running an independent practice.
- Scheduling and efficiency analysis: Ensure that your MD and CRNA time is being used efficiently, and optimize schedules based on facility, preferences, seniority, internal systems, and other factors.
- Credentialing support: Your anesthesia billing company can support and take care of all of that paperwork and verification for you.
- Transparent reports: Have complete visibility and insight into how your practice is doing. Reports should show reimbursement rates, expected cash flow, collected vs. expected amounts, days in accounts receivable, and revenue and provider comparisons.
Part 2: How to Pick the Right Anesthesia Billing Company: Hospital Anesthesiology Departments
Anesthesia expertise is not only required for independent groups, it’s also necessary to generate maximum revenue for a hospital’s anesthesia department. Hospitals that use a single service for all of their billing rely on systems and knowledge that have been optimized across all specialties. One-size-fits-all billing processes are not optimized for specialties like anesthesiology with outlier requirements.
Anesthesia billing uses unique codes and modifiers. Without a comprehensive understanding of these specifics, your billing company could be missing out on potential revenue—or worse, overbilling.
Worse than underbilling are regulatory and compliance issues that can cause overbilling. This can be a problem when general coders try to handle complex anesthesia billing.
Epic Systems was previously sued by hospitals who (mistakenly) double-billed anesthesia services to Medicare and Medicaid for hundreds of millions of dollars. This was apparently due to a faulty default software setting—but the fact that this issue went unnoticed by so many general billing experts for so long shows just how important it is to have specialty-specific expertise and oversight in your anesthesia billing.
The sad truth of the anesthesia billing and payment system is that payors rarely pay according to their contracted amount. In order to collect maximum appropriate revenue, your billing department needs to have a system in place, or partner with an outside billing service, that tracks every payment for every procedure for every contracted payor, and ensures that each payment matches the correct contracted amount. Otherwise, your collections will often be off—and significantly lower than your contracted amounts.
At Fusion Anesthesia, we do this by completing reconciliation not only for every claim, but for every single line item on that claim. It sounds like a lot of work (and it is), but we utilize our proprietary software that holds the up-to-date reimbursement rates for every payor, service, and client. The system automatically flags any item that doesn’t meet the contracted requirements. When those flags pop up, we resubmit paperwork and dispute the claim over and over again until it is paid in full.
If you want to determine if your current billers are maximizing revenue, look at a line-by-line reconciliation log for the past six months. If it doesn’t exist or if it doesn’t show a significant number of claims kicked back, then you’re almost certainly missing out on legitimate revenue… because payors rarely pay every claim as contracted.