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How Anesthesia Billing Works – General Medical Billing vs Anesthesia Specific Billing Companies

Anesthesia is a medical treatment that prevents patients from feeling pain during surgery.

Anesthesiology is a specialized trade, and requires specialty billing. The billing for anesthesiologists is very different from billing for other specialties within the medical field.

How Anesthesia Billing Works:

Most Anesthesia Billing charges are typically calculated using four different factors:

Base Unit: The base unit is assigned to the procedure by the ASA. This is used to establish the base fee.

Time Unit: The time unit is the length of time that the anesthesia provider is with the patient. One-time unit is typically 15 minutes, but this could differ depending on the location.

Modifying Factor: Not all procedures will contain a modifying factor. This is where special conditions that affect the anesthesia plan can be accounted for. Patient health could be a modifier factor.

Conversion Factor: The conversion factor helps translate the base unit into a dollar amount, which will vary from provider and location.

Typically, the Anesthesia Billing Charge looks similar to this:

(Base Unit + Time Unit + Modifying Unit) * Conversion Factor = Anesthesia Charge

 

When anesthesia providers search to find a company to do their billing, they will find that there are general medical billing companies, and anesthesia specific billing companies.

General medical billing companies are built to maximize collections across all departments. Generally, this is successful. However, anesthesiology maintains its own unique billing procedures and very specific billing rules. Anesthesia billing requires its own specialized software and billers who are deeply skilled with  anesthesia codes. When the generalized billing companies collect revenue for the anesthesiology department, they miss a significant portion of these specifications, which equals a loss of revenue collections for the anesthesia department.

In addition to loss of revenue, generalized medical billers risk regulatory compliance problems when general coders attempt to handle the complex work of anesthesia billing.Billers must be very careful when coding for anesthesia billing. One general medical billing company was recently sued due to inappropriately charged anesthesia billing. Seemingly, a 30-minute, 4 base unit procedure was being incorrectly billed at 34 units (4 base units + 30 minutes), rather than correctly billed at 6 units (4 base units + 2 time units). This caused numerous clients to be fraudulently double billed to Medicare and Medicaid by hundreds of millions of dollars. A simple algorithm programming error within the medical billing company resulted in this massive and costly ordeal.

Anesthesia billing is unique and complex. In order to maximize the revenue in your anesthesiology department and reduce liability, partner with an anesthesia billing specialist. Anesthesia billing specialists, who focus 100% on anesthesia, have the right people who are specialized in anesthesia billing, the right software, the ability to go through your contract line-by-line and reconcile the contracted amounts, and are able to maintain a deep level of understanding with the constantly evolving laws, regulations, code changes and tax rules. It’s a big job, and can only be done properly by dedicated anesthesia billing specialists.

When looking for the right anesthesia billing company for your practice, there are several things to look for.

First, require that your billing choice is an anesthesia-specific billing company. This will ensure that the company understands the specializations of anesthesia and all the unique biller codes and modifying factors.

The company must also focus on maximizing your revenue through their collection rate. Some anesthesia billing companies only collect 80% of expected collections, while others are able to collect up to 95-97%.

A great anesthesia billing company will also provide customized real-time reporting. The reports should show reimbursement rates, expected cash flow, collected vs expected, days in accounts receivable, year-to-date revenue comparisons and provider comparisons. If your billing company does not have these reports, that means that they are not using these reports, which means that they aren’t doing their job of maximizing your collections. Total transparency and accurate reporting is critical for any billing company that you work with.

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