Billing for anesthetic services is not like regular medical billing. You must not only grasp how anesthetic is provided but also comprehend payer regulations, or your claim may be refused. In fact, anesthetic billing necessitates contributions from everyone, from the billing team member to the physician.
Here are a few of the successful tips to help you get the most out of your billing system while also ensuring your practice complies with rules and increases revenue:
Bill the Procedure with the Highest Base Value
Examine the code descriptions for the procedures you perform carefully, primarily if you operate in multiple spine or abdomen locations. While you can’t bill for more than one operation at a time, some ASA codes include many areas in their descriptions (for example, surgeries involving multiple spinal segments) and hence have higher base units. Selecting the most precise code bill can assist you in avoiding under-billing for your work.
Document Medical Necessity
Many payers also require medical necessity documentation for reimbursement of post-op blocks. Furthermore, certain Medicare Administrative Contractors (including WPS) now require a surgeon referral for the post-op block. Make sure you understand the paperwork and referral criteria for your insurance payers. In brief, in order to pay for the service, most payers want medical necessity verification.
Properly Calculate Time Units
Calculating time and base units is essential to anesthetic medical billing, yet it is frequently error-prone.
Understanding appropriate time unit calculation necessitates familiarity with the many formulas at work. To calculate the total units for billing purposes, time units are added to whichever base units are assigned to the method.
For example, Commercial insurers utilize the formula Base Units + Time Units + Physical Status Modifier = Total Units.
To determine time units, divide the entire number of minutes spent on a procedure (from start to finish, including any breaks) by 15. Any segment exceeding seven minutes is rounded up to fifteen minutes. So, a process lasting from 8:00 a.m. to 9:08 a.m. would be worth five units, not four. However, many forms require you to give the exact minutes (in this case, 68 minutes).
Remember that anesthetic time is defined as the time when the practitioner is present with the patient.
Know your Modifiers- Anesthesia Billing & Coding
Modifiers are essential for any anesthetic medical billing specialist to understand as they are significant in getting adequately reimbursed. There are various modifiers, including, but not limited to:
AA: Anesthesia Services provided by the anesthesiologist personally.
AD: Physician medical supervision; more than four concurrent anesthetic operations
QK: Medical direction of two, three, or four concurrent anesthetic procedures involving competent personnel.
QY: An anesthesiologist oversees the medical care of one CRNA/AA.
QX: CRNA/AA service under the medical supervision of an anesthesiologist.
QZ: CRNA services without anesthesiologist supervision
Modifiers are specific and must be used with caution. Many claims were denied or delayed due to inaccurate or missing modifiers.
Have a Reconciliation Process in Place
Another critical step toward successful anesthesia billing and coding is ensuring your bill for each service delivered to each patient. A single ignored case might result in a revenue loss of hundreds of thousands of dollars. Billing staff and physicians must collaborate to ensure that all charges are billed. Is there a system in place? If not, look for an outsourcing anesthetic billing partner.
Contact 24/7 Medical Billing Services Team!
Outsourcing an anesthetic medical billing company specializing in billing and coding is the best approach to assure correct compliance and the total collection of all potential income. This saves overhead by reducing in-house staff and lowers total costs through improved collections and payments. You can also avoid refused claims or payment delays more effectively than most clinics can with an in-house team.
Given the difficulties of anesthetic billing, outsourcing your anesthesia medical billing to 24/7 Medical Billing Services should be considered. At 24/7 Medical Billing Services, we bring together the best medical billers in the country and combine our global resources to provide healthcare providers with specialized solutions for optimal revenue cycle management and anesthetic medical billing services. Thanks to decades of industry knowledge, cutting-edge technology, and vital intelligence, we can help you maximize your earnings while focusing on treating your patients.
To learn more about correct coding and billing for anesthesia practitioners, contact our experts.