Top 6 Challenges in Anesthesiology Billing and Their Solutions – A Complete Guide

Did you know? The average annual healthcare claim denial rate is between 6% and 13%, pushing many hospitals into the danger zone. Coding errors, documentation inconsistencies, eligibility issues, and timely claim submission are critical causes for this huge denial rate.

The financial stability of a healthcare provider and cost management are highly depend on the accuracy and timeliness of healthcare billing. But the sector is hurdled by numerous medical billing challenges, leading to denials, underpayments, and penalties.

The specific nature of the anesthesiology service itself adds an additional layer of complexities. The multi-layered billing approach for Anesthesiology and compliance with the ever-changing coding regulations are major challenges in the anesthesiology billing process.

Handling these challenges eats away at the providers’ time spent on patient care and also impacts cost management. Are you looking for strategies to overcome these hurdles and optimize anesthesiology revenue cycle management? This blog is for you.

Understanding the Anesthesiology Billing

The anesthesiology billing team faces a unique set of challenges in claiming accurate reimbursement. Unlike many other branches with a single code per procedure, anesthesiology billing is not straightforward. It follows a multi-layer approach to coding.

First let’s understand the key components involved in anesthesiology billing:

• Base Unit: A code that corresponds to the type of anesthesia administered (spinal, general, etc.). Every year the CMS publishes the base units.
• Time Units: Time spent with the patient is calculated as units, which is often 15 minutes per unit.
• Modifiers: Any complexities or unusual procedures are accounted for, and each circumstance corresponds to additional codes.

For example, there are different codes corresponding to Monitored Anesthesia Care Services (MAC), MAC for patients who have a history of severe cardio-pulmonary conditions, etc. Similarly, there are codes for anesthesia performed for a broader range of diagnostic or therapeutic services, and also for more narrow services, like anesthesia for a specific surgery.

Anesthesiology Billing Challenges

In addition to these billing components, here are some common challenges that make anesthesiology billing more complex:

1. Time-based Reporting

Anesthesiology billing requires accurate calculation of the time spent with the patient. But measuring the time can be challenging due to fluctuating case lengths. It varies based on the complexity of the procedure and unexpected complications.

Moreover, the Anesthesiologists might be interrupted during the procedure to attend to urgent situations. Documenting these interruptions and factoring them while billing is crucial to avoid under-coding.

2. Complex coding and documentation requirements

Accurate and thorough documentation of the medical processes is needed for proper coding. This document should include meticulous details about the type of anesthesia administered, pre-operative evaluation, monitoring during the surgery, and post-operative care.

Moreover, the type of surgery performed greatly influences the anesthesia billing process. Coders must map the correct anesthesia code corresponding to the corresponding surgical code.

3. Patient eligibility and benefits verification

Before treating the patient, verifying their insurance eligibility and specific coverage for anesthesia services is crucial. This helps understand the coverage limitations that can lead to claim denials from insurance companies. This impacts the revenue collection for the provider and the hospital.

4. Constant regulatory updates

The healthcare industry undergoes frequent regulatory changes in billing and coding. Staying updated on these changes is critical to remain compliant. And, non-compliance with the latest regulations can result in claim rejections and potential fines.

5. Rejected claims and appeals

The complex billing process makes anesthesiology claims more susceptible to denials by insurers. In case of denials, expertise in coding and billing regulations is necessary to process appeals. Understanding the reasons for denials and communicating them to the insurance companies is necessary to get these claims reprocessed.

6. Coordinating with multiple providers

Anesthesiologists work alongside surgeons, nurses, and other healthcare professionals during the procedure. Clear communication and collaboration are required to document all the services offered, from pre-operative evaluation to post-operative care, which should be accurately reflected in the billing.

Solutions to Solve Anesthesiology Billing Process Challenges

By understanding these key components and challenges in Anesthesiology billing, the team can draft efficient strategies to streamline the billing process and improve revenue collection. Here are some effective solutions:

1. Improve communication and collaboration

Clear communication and collaboration between anesthesiologists, surgeons, nurses, and the billing team is vital in ensuring accurate documentation. It minimizes discrepancies that might lead to future denials.

2. Routine Eligibility Verification prior to patient visit

Even before the surgery is performed and the services are offered, it is crucial to verify the patient’s insurance eligibility. The billing team must take proactive steps to verify the patient’s insurance coverage before performing the anesthesia services. Doing so avoids any coverage-related surprises and financial losses. Also, patients can be given prior communication regarding the cost they have to bear from their pockets.

3. Follow proper coding and documentation guidelines

The billing team should have an in-depth knowledge of the coding systems and documenting guidelines. Healthcare providers and hospitals should invest in training their billing team in revenue cycle management to understand base unit costs, time units, and modifiers. Moreover, some specialized knowledge about the specifics of anesthesia care is vital to avoid denials.

4. Regularly audit anesthesia billing records

Implementing regular audits for Anesthesiology billing records helps in the early identification of any errors or inconsistencies. This approach helps in timely corrections, minimizing denial risks.

5. Implement automation technologies and advanced billing software

Advanced billing software and automation tools can be leveraged to make the billing process faster and more accurate. Automation minimizes the risk of human errors in data entry and coding, leading to reduced claim denials. Also, automating repetitive tasks like claim scrubbing and submission frees valuable time for your billing team to focus on more complex cases.

6. Consider Outsourcing Billing

Qualified medical billing companies have the expertise and resources to handle complex billing processes efficiently.  This allows them to streamline the process and optimize revenue cycle management. This is a strategic advantage and it allows anesthesiologists to focus on patient care.

By implementing all these practices, anesthesiologists can efficiently handle the complexities of billing and optimize their revenue cycle management.

How can Atlantic RCM Solve this Problem?

Atlantic RCM is a medical billing and Revenue Cycle Management specialist. We offer a suite of services that specifically address these challenges and ensure smooth financial operations for healthcare providers.

Our team of experienced professionals is well-versed in the nuances of anesthesiology billing, reducing your administrative burden. We handle insurance verification, prior authorization, and denial appeals, all while adhering to the regulations.

Partner with Atlantic RCM to streamline your billing, maximize revenue collection, and free up your time and resources to focus on what you do best – patient care.

Contact us today for a free consultation.

Atlantic RCM is one of the leading multi-specialty medical billing companies in USA that serves 25+ major medical billing specialties. Our experts work across your practice in billing, collections and account receivables management, to help you succeed.

Get in touch with the leading medical billing outsourcing company to learn more. Call us at (469) 501-1500 or write to us Info@atlanticrcm.com