Anesthesiology is a highly specialized and complex service with an equally complex billing formula. There are many rules and guidelines that are specific to anesthesia care and the formula used to determine reimbursement is unique to anesthesia. Below are just a few of the benefits of outsourcing your anesthesia RCM that we’ve learned through our partnerships with hospital clients:

Electronic Health Records (EHRs): Great for charting not for billing

Most hospitals and hospital owned Ambulatory Surgery Centers are using some type of (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.

Modifiers

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 some private payers do, and these reimbursable charges are often missed.

Non-Operating Room Anesthesia Procedures (NORA)

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.

Case Reconciliation

In our experience, most hospitals do not have a process in place to ensure every single anesthesia services is captured and billed. As a billing company, we work with our clients to obtain a final surgical schedule for every anesthetizing location which is used as a foundation for comparison against cases received.

Reporting

EHRs are often incapable of allowing the extraction of anesthesia specific billing data such as volume by procedure category i.e. Surgical/OB/Cardiac/Acute Pain, etc. During information discovery with potential hospital clients, we also find most EHRs cannot provide accurate revenue information for anesthesia professional billing.

Outsourcing the anesthesia revenue cycle management to vendor specializing in anesthesia will undoubtedly increase revenue. Many hospital leaders fear outsourcing this service will result in a lack of oversight of the revenue cycle, however, in our experience it improves it. Through technology and reporting we can provide our hospital partners with data on anesthesia services and revenue that they never had access to before.

If you’d like to learn more about a Fusion Anesthesia Solutions partnership for your hospital or employed medical group, contact sales@fusionanesthesia.com today.

By: Jeanette Mini