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November 24, 2015

Common Challenges with Anesthesia Billing

November 24, 2015

anesthesia billing company

Anesthesia billing differs from most other physician billing, in which there is generally a fee-for-service-based payment. Instead of being on a fee-for-service schedule, anesthesia providers are paid according to a different system consisting of base units, time units, and modifiers.

The more-complex nature of anesthesia billing means there is more potential for error, which can result in denied claims, delayed payments, or worse – RAC audits.

Anesthesia providers and their staffs have to deal with several challenges and difficulties with anesthesia billing that make the process more complicated and involved than what other providers have to experience. Navigating these challenges is essential for the financial health of a practice.

Here are common issues with billing for anesthesia providers and how they can be mitigated.

(Read more on an important update on anesthesia billing procedures.)

Challenges with Report Time

Since time units make up a major component of how anesthesia providers get paid, it is essential that time is recorded and reported accurately.

Report time isn’t as simple and straightforward as denoting when care begins and ends. There are several points in which reporting time can be confusing and/or complicated, which can result in lost revenue and potentially audits and penalties.

For example, there is the notion of relief time. Relief time occurs when one anesthesia provider takes over the current case from another anesthesia provider, in a situation in which there should be two start-stop timelines reported on the record and ticket. Documenting relief time is important and needs to be accurate, otherwise time can be incorrectly reported.

The same general principle applies with discontinuous time. Discontinuous time refers to breaks in anesthesia care in which the provider leaves the patient for whatever reason. In this instance, the only time that should be reported is that which is continuous. In other words, a record must show that care was stopped and started multiple times, and the total sum of anesthesia care must be reported. In this case, it helps to show the blocks of time before and after care was interrupted, along with checking the discontinuous time box.

Finally, be careful with time spent in the post-anesthesia care unit (PACU). Medicare has determined 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 records. Checking records for these anomalies is important.

Cancelled Cases and Monitored Anesthesia Care

If a patient’s case is cancelled before induction can begin, the reason for the cancellation must be clearly recorded, along with the evaluation and management (E/M) code that applies for the situation. It’s important to accurately and thoroughly record cancellations so that a complete record can be submitted with correct modifiers.

Monitored anesthesia care (MAC) must also be carefully recorded. If a patient loses consciousness, for example, then the resulting time spent should be considered general anesthesia instead of MAC. Different carriers have different standards and specifications that need to be monitored and observed for MAC.

Ensuring Better Anesthesia Billing

There are other common challenges with anesthesia billing that we will cover at a later date. Providers need to know that the above challenges and other difficulties can be avoided or mitigated with help of a professional anesthesia billing provider that specializes in billing for these providers and knows the ins and outs of billing and coding in a challenging space.

Consult with Medical Business Management and learn more about how working with us can help eliminate these difficulties from your practice.

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