Anesthesia billing varies from most other physician billing, in which there is usually a fee-for-service-based payment. However, alternatively being on a fee-for-service program, anesthesia providers are reimbursed according to a diverse practice consisting of time units and modifiers. The more complex nature of anesthesia billing means there is more potential for error, denial of claims, delayed payments, or worse audits and try to avoid common anesthesia billing mistakes.
Anesthesia providers and their team have to deal with numerous challenges and complications with medical billing and coding, making the process more complicated and involved than what other providers have to endure.
Here are some fundamental issues with billing for anesthesia providers and how they can mitigate them.
- Difficulties in Reporting Time
Considering time units make up a significant segment of how anesthesia providers get paid, time must be logged and reported precisely.
Report time isn’t as easy and straightforward as signifying when care begins and ends. There are several details in which reporting time can be confusing and complicated, appearing in lost revenue and potential audits and fines.
The same common principle applies with irregular time. Intermittent time refers to differences in anesthesia care in which the provider leaves the patient for whatever reason. In this case, the only time that should report is that which is continuous. In different words, a record must note that care was stopped and started multiple times, including the total sum of anesthesia care that needs to be reported. In this case, it serves to show the blocks of time before, and aftercare was hindered and checked the discontinuous time box.
Lastly, be cautious with time spent in the post-anesthesia care unit (PACU). Medicare has concluded that the average PACU time is seven minutes. An aggregate of cases above the seven-minute mark will look suspicious to auditors without supporting documentation – and that means clear reports. Checking records for these anomalies is vital.
- Canceled Cases and Monitored Anesthesia Care
If a patient’s case is canceled before initiation begins, the cause for the cancellation must be recorded, along with the evaluation and management (E/M) code that applies to the situation all the time. Therefore, it’s essential to accurately and thoroughly record cancellations to submit the complete record correct modifiers.
If a patient loses consciousness, then the resulting time spent should be considered general anesthesia instead of Monitored anesthesia care. This is because different carriers have different standards and specifications that need to be monitored and observed for MAC.
- Assuring Better Anesthesia Billing
There are other shared challenges with anesthesia billing that we will cover later on. Firstly, providers need to know that the above difficulties and other complications can be avoided or mitigated with the help of a professional anesthesia billing provider specializing in billing for those providers and understands the ins and outs of billing and coding.
- Documentation errors
Errors with documentation of anesthesia remain one of the significant and common mistakes made in hospitals. However, documentation errors cause more issues with billing than they do for the patient’s safety.
Basic documentation errors include:
• Closing the Surgical Procedure(s) section of a patient’s anesthesia record before the surgery is finished
• Unclear documentation declaring the primary objective of postoperative pain management
• Surgeon’s documentation of demand for postoperative care supervision
While these errors cause more problems for medical billing, hospitals have a high demand for efficiency in all areas of their organization. Therefore, hospitals should consider processes that ensure the right people perform documentation at the appropriate times.