When it comes to anesthesiology billing, timing is everything – literally.
More emphasis is placed on the timing around a procedure in anesthesiology billing than perhaps any other specialty, due to the inherent nature of the practice. To bill correctly – and avoid costly audits, as we previously discussed – it’s essential to properly record timing for any and all procedures.
Audits happen because practices, for a variety of reasons, fail to accurately record timing. It is one of the leading causes of RAC audits that can cost a practice thousands of dollars. Plus, outside of audits, improper timing can deprive a practice of payments and result in delayed or rejected claims.
To assist, we have prepared a brief primer on timing for anesthesiology billing.
Exploring Time Units and Start Time
Anesthesia providers get paid on claims submitted to payers based on three components: base units, time units, and modifying units.
Per the Medicare Claims Processing Manual:
“Anesthesia time begins when the [anesthesia provider] starts to prepare the patient for the procedure. Normally, this service takes place in the operating room, but in some cases, preparation may begin in another location (i.e. holding area). Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service.”
Under guidelines, the anesthesia provider is in constant contact with the patient. To begin start time, there must be an action shown on the anesthesia record that indicates time. Usually, this includes vital signs and the procedure being performed along with the time care began.
Ensuring Correct Anesthesiology Billing
It’s important that both the time on the anesthesia record and the time being billed match each other perfectly. Many audits have punished practices for inconsistencies in recorded and billed time.
Also, capturing accurate time during breaks and/or end of shifts is critical.
Times also should never be rounded. Medicare time units are in fifteen-minute increments, paid at one-tenth of a minute increments. Commercial insurance may have other specified time units.
There may also be the need to document discontinuous time. The record must clearly show when anesthesia time begins and ends over the course of an entire session, and the time on the record must match the time being billed. Discontinuous time isn’t for relief issues or for when an anesthesiologist must leave during a case. It is for when anesthesia is stopped, such as during a delay.
Furthermore, billing goes to the provider who spent the longest amount of time on the case. If the first anesthesia provider begins the case and provides care for an hour, and a second anesthesia provider comes in and provides care for the rest of the case (that lasts four hours), the second provider would be the billing provider.
Outsourcing Anesthesiology Billing
The best way to ensure correct timing when it comes to billing is to hire an anesthesiology billing company to handle your claims and processes.
An outsourced company can remove stress and help avoid audits or delays in payment. For more information, contact Medical Business Management and learn more about our processes and how they benefit providers across the country.