Billing for anesthesia services isn’t your run-of-the-mill medical billing. Not only do you need a basic understanding of how anesthesia is administered, you need to know the ins and outs of payer requirements or your claim may be denied. And, anesthesia billing requires something of everyone—from the billing team member all the way to the physician.
We want to help you succeed at anesthesia billing. I recently sat down with Andrea Halpern, CIPROMS vice president of client relations, to compile a list of her top 10 anesthesia billing tips.
- Have a reconciliation process in place. The first step to successful anesthesia billing is to ensure you are billing for every service provided to every patient. Just one overlooked case could mean a loss of hundreds of dollars of revenue. Billing teams and physicians need to work together to ensure that all charges are being billed. Do you have a system in place?
- Know the rules for start and stop times. The American Society of Anesthesiologists (ASA) offers a simple definition in their Relative Value Guide. The Centers for Medicare and Medicaid Services (CMS), along with other commercial payers, have similar definitions. Following the rules for start and stop times will help you remain compliant and avoid over-billing, overlapping cases, and red flags like five minute increments.
- Bill the procedure with the highest base value when providing multiple procedures. Look carefully at the code descriptions for procedures you are performing, especially when working in multiple areas of the spine or abdomen. While you can’t bill codes for more than one procedure, some ASA codes include multiple areas in their descriptions (like surgeries across multiple vertebral segments) and thus have higher base units. Choosing the most precise code bill help you avoid under-billing for your work.
- Document medical necessity for Monitored Anesthesia Care (MAC). The ASA offers general guidelines for how to document medical necessity. Most payers require medical necessity documentation in order to pay for the service.
- Document medical necessity for acute post-op pain blocks and possibly get a referral. Many payers also require documentation of medical necessity for payment of post-op blocks. As well, some Medicare Administrative Contractors (include WPS) now require a referral from the surgeon for the post-op block. Be sure you understand the guidelines both for documentation and referrals for your payers.
- Prepare for ICD-10 through clinical documentation improvement and code set familiarity. Anesthesiologists have it particularly rough when it comes to the specificity of ICD-10 since they are relying on the surgeon for much of the information about the patient and his condition. Familiarize yourself with what is required, and determine how you can get the information you need to properly code using ICD-10.
- Document all qualifying circumstances and bill payers when appropriate. While not all payers (including Medicare) will reimburse separately for extreme age, hypothermia, or other qualifying circumstances, some will. Indiana Medicaid, for instance, still reimburses for extreme age. So be certain to indicate it on the billing sheet and submit it on claims when applicable.
- Be aware and participate in quality programs, especially CMS programs that will result in a penalty for non-participation. Physicians who do nothing when it comes to quality reporting could face up to 13 percent reductions on Medicare payments by 2019. Quality programs are here to stay. Determine today how you can begin to participate and report quality measures.
- Regularly review and negotiate your payer contracts. When was the last time you pulled out your payer contracts? Do you know which payers you contract with? Plan to review your contracts annually, starting today. And be sure you are getting fair-market value using the ASA’s annual payer survey results.
- Monitor your charge master. What are you charging per unit for your anesthesia services? And what about the non-anesthesia services you perform? When is the last time you evaluated how much you are charging? Payers often set their fee schedules based on the average charges they receive from providers. Make sure you aren’t losing revenue by undercharging for your services.
Chances are you are already doing most of these things … but is there one item on the list you could spend a little more time on starting today?
Finally, a bonus tip for those who are in the business of anesthesia and anesthesia billing: don’t forget to talk with others in the same business for additional tips and resources by attending conferences and joining local and national professional organizations. By being involved, you will stay up-to-date on all the latest in anesthesia billing.
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