External audits are one of the most effective ways to evaluate how well your anesthesia billing service is performing. However, audits can be time-consuming and expensive. While the insights they provide are often invaluable, we’ve developed a practical alternative — a set of five key questions anesthesia groups can ask themselves (and their vendors) to assess billing performance without the need for a formal audit.

1. Ask for the Net Collection Percentage by Payor

Net collection percentage is a critical performance metric that directly reflects how well your billing service is performing. The formula is simple:
Net Collection % = (Dollars Collected ÷ Contracted Amount) × 100

Your billing company should have your payor contracted rates loaded into their system, allowing for real-time tracking of expected vs. actual collections. At Fusion Anesthesia, our clients have 24/7 access to this data via CogitoAnalytics, our proprietary analytics platform that delivers near real-time data and reporting.

👉 Tip: If you’re unsure of your current net collection percentage, ask your billing company to provide it over a specific period along with the exact formula they use. Pay attention to how quickly they respond and whether their data backs up their claims.

2. Are All Payments Reviewed for Accuracy? 

This ties directly back to your net collection percentage. If your payor contracts are properly loaded into the billing system, any underpayments should trigger alerts for follow-up. Payors frequently underpay claims — often subtly — and unless these discrepancies are caught and appealed, you may be losing out on substantial revenue.

It’s easy for billing services to collect the first 80% of what’s owed. But it’s that final 20% — often the most labor-intensive — that truly tests your vendor’s commitment. These harder-to-collect dollars can significantly impact your practice’s bottom line.

3. Does Your Billing Company Support Payor Contract Negotiations? 

Your billing partner should be actively involved in helping you navigate and renegotiate payor contracts. This has become even more critical in the wake of the No Surprises Act, which has introduced new complexities into the negotiation process.

Key expectations from your billing vendor:

• Tracking contract expiration dates to allow time for proactive negotiations
• Reviewing current contracts and recommending increases based on:
  • ASA Annual Conversion Factor Survey Results
  • Additional benchmarking and internal analytics
• Delivering a payor matrix that outlines:
  • Current conversion factors
  • Flat fee amounts
  • Contract expiration dates
  • Suggested negotiation strategies

4. What Type of Reporting Do You Receive?

While most billing vendors provide standard month-end reports, those using multi-specialty billing systems may be limited in how they present data or customize reporting for anesthesia.

In today’s data-driven environment, anesthesia groups need customizable, real-time reporting with access to the raw data behind those reports.

Ask your billing vendor:

• Can we customize reports and dashboards?
• Can you provide patient-level and claim-level detail?
• Is the data available in a format we can audit independently?

At Fusion Anesthesia, transparency is fundamental to our client relationships. Our clients enjoy detailed visibility in every metric that matters.

5. Is There a Reconciliation Process to Ensure No Charges Are Missed?

Even with EHR integration, missed charges remain a risk — especially in NORA (Non-Operating Room Anesthesia) locations or with facilities that still rely on paper records.

Your billing company should have a comprehensive reconciliation process to ensure all cases are captured, including:

• Collaborating with each facility’s IT team
• Verifying that all anesthetizing locations are tracked
• Matching daily surgical schedules to billing data
• Alert systems for missing or delayed case records

Ask your vendor what their reconciliation process looks like. Do they proactively flag missing cases? Are all facility locations accounted for?

Want a Second Opinion?

If you’re unsure about how your current billing vendor is performing, we’re happy to help. Fusion Anesthesia Solutions offers expert guidance, deep industry knowledge, and real-world benchmarks to help you make informed decisions.

📩 Contact us at sales@fusionanesthesia.com
We’d love to learn more about your practice and share how we’ve helped other anesthesia groups maximize collections and streamline billing operations.