The Benefits of Outsourcing Your Hospital’s Anesthesia Revenue Cycle: Part 1 of our Revenue Cycle Health for Hospitals Series

Part 1 of our series on Revenue Cycle Health for Hospital Anesthesiology Departments will focus on the complexities involved in anesthesia coding and billing. There are many rules and guidelines that are specific to anesthesia care not to mention the formula used to determine payments is unique to anesthesia.

Most hospitals are now using some type of Electronic Health Record (EHR) and while those EHRs are great for capturing patient information and charting, we have found many deficiencies when it comes to billing for anesthesia services. There are often disconnects between anesthesia clinicians on where services such as blocks should be documented and whether the hospital billing staff is receiving those charges to bill.  Seasoned anesthesia coders and billers will know what procedures have ancillary anesthesia services to be billed whether or not the service has been documented (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 as the maximum number of procedures that the anesthesiologist is medically directing within the context of a single procedure and other procedures overlap each other. Unless you are utilizing an anesthesia specific billing platform that is designed to identify errors, such as concurrency, you may create compliance issues for your hospital. Once all charges and times are entered, an anesthesia specific billing platform will run a concurrency analysis to identify overlapping times, invalid times, inconsistent or suspect coding, and modifiers, etc.

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) as well as 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 and these reimbursable charges are often missed.

Non-Operating Room Anesthesia procedures (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 must be manually extracted from the hospital EHR and most hospitals do not have a process in place to capture these procedures nor has the staff been trained to recognize this is an issue. We will explore reimbursement further in Part 2 of our series on Revenue Cycle Health.

For further insight on your anesthesia revenue cycle health contact Fusion Anesthesia Solutions at sales@fusionanesthesia.com.

Stay tuned for Part 2 in our series on Revenue Cycle Health for Hospital Anesthesiology Departments.