Anesthesia billing is hard. Yes, we have said it over and over but it’s true. Without the right tools, people, and expertise in billing and collections you could be losing money (anywhere between 5 and 15 percent of your potential revenue).
How do you know if you’re actually missing revenue?
There are two good ways to estimate if you’re missing legitimate revenue from your billing process.
1. Look at your average collections per billing hour.
For a quick and dirty understanding of your collections, compare your average (collected) revenue with the number of hours worked by your anesthesiologists and CRNAs.
If your numbers are lower than the MGMA averages… you’ve likely got a problem.
2. By performing a comprehensive billing analysis on a random sample of cases.
The best way to investigate and quantify potential lost revenue or inappropriate billing habits is to analyze a random sample of relatively recent cases.
Without a complete anesthesia billing analysis, you may never know if you’re missing out on potential revenue.
This analysis includes:
- Documentation Review: A thorough examination of the claims to identify possible deficiencies in initial claims generation and write-up.
- Coding Review: An assessment of the coding that was assigned to services to ensure compliance with applicable industry and payer guidelines. This includes double checking that all base units, time units, and modifying units were calculated correctly based on contracted agreements.
- Billing and Reimbursements Review: A claims reimbursement analysis to ensure that appropriate reimbursement was received for the services provided.
What’s Required of You
The medical billing analysis process probably sounds like a good idea in theory, but it may also sound like a lot of work. However, luckily for you, we’ll do all the heavy lifting. You just have to gather up the files for 25 cases or so and send them over.
You already have everything you need to have your medical billing analysis completed.
Recommended Sample Size
To have a quality sample for analysis there are two options. First, you could provide at least 10 cases for each physician including cases from all practice facilities and all major payers. Or second, in order to evaluate medical direction simply provide all cases from at least one date of services. In order to determine what revenue has been lost on these claims, it is recommended that they are closed cases that are at least six months old. If there’s a pervasive problem, we’ll probably find it with just these cases.
Looking at closed cases helps better determine where your existing anesthesia billing company didn’t adequately follow up.
All of this information should be readily available in the case file. For each case included the following paperwork must be submitted:
- Pre-anesthetic exam
- Perioperative anesthesia record
- Block sheet *
- Operative report
- Post-op pain order sheet *
- rogress notes for post-op pain *
- Post-anesthesia visit
- Documentation for pain management services
- Patient demographics/insurance data
- Claim formatting (copy of CMS-1500 or electronic equivalent)
- Log of all billing activity (including claim submission, payment, denial, and all follow-up activity)
- All explanations of benefits for claims in the sample
*only if applicable
Free Anesthesia Billing Analysis
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