For a free consultation, call
800-477-4544
Contact Us

November 20, 2024

How 2025 Healthcare Policy Changes May Impact Anesthesia Practices

November 20, 2024

The healthcare industry changes by the minute, and 2025 promises to bring a wave of policy shifts that will directly impact anesthesia providers and practices. 

At Medical Business Management (MBM), we’re a leader in billing, coding, and practice management services for anesthesia providers 一 and we’re dedicated to staying ahead of industry trends. 

From Medicare payment reductions to potential insurance policy reversals, this year’s healthcare policy landscape poses challenges, but also opportunities. Our goal is to help anesthesia providers understand these changes to protect their financial performance and maintain a high standard of patient care. 

Let’s examine how 2025 policy updates may impact your anesthesia practice‘s billing processes and revenue cycle management

(1) Medicare Payment Reductions

First on our list: the Centers for Medicare & Medicaid Services (CMS) has finalized a 2.20% reduction in the Anesthesia Conversion Factor (CF) for 2025, decreasing it from $20.7739 in 2024 to $20.3178. For anesthesia providers in the United States, this translates to reduced reimbursement rates for services rendered to Medicare patients. 

While the change may seem modest, its cumulative financial impact can be significant for practices with a high volume of Medicare cases. The reduction highlights the ongoing strain on the Medicare payment system, where reimbursement rates often fail to keep pace with the rising costs of delivering care. 

The decrease also validates the need for reform regarding the complexities and critical nature of anesthesia services. This year, practices may need to reassess operational budgets, explore diversification of payer mixes, and identify efficiency improvements to mitigate the impact of reductions.

MBM assists providers with these concerns through outsourced medical billing services. We help practices identify opportunities to offset losses through optimized managed billing, coding, and payer negotiations. 

With us, you can be proactive about your cash flow and promote a stable revenue cycle in 2025’s challenging anesthesia reimbursement field.

(2) Merit-Based Incentive Payment System (MIPS) Updates

This year, CMS has proposed maintaining the performance threshold for MIPS at 75 points, a continuation of the 2024 benchmark. The data completeness criteria also remain steady at 75%, providing consistency for participants through 2028. 

This stability in reporting requirements is welcome news for anesthesia medical practices, as it allows practices to focus on quality improvement initiatives without the burden of adapting to new benchmarks.

The anesthesiology measure set remains unchanged, which means providers can continue using the same quality measures they’ve implemented in prior years. However, CMS is introducing six new MIPS Value Pathways (MVPs) for other specialties, a step toward improving reporting processes and aligning them with patient care goals. 

While none of the new MVPs directly target anesthesiology, healthcare providers should certainly stay informed about potential future additions that could impact their reporting requirements and billing services.

(3) Insurance Policy Reversals

As you likely already know, Anthem Blue Cross Blue Shield announced a controversial policy in 2024 that proposed limiting anesthesia coverage based on predetermined time limits for procedures. 

This policy raised alarms across the medical community, with critics emphasizing that such arbitrary caps disregarded the complexity and variability of patient needs during surgery. Physicians and professional organizations, including the American Society of Anesthesiologists, were vocal in their opposition, highlighting the potential risks to patient safety and the erosion of provider autonomy.

In response to the overwhelming backlash, Anthem reversed its decision in December of 2024 and reaffirmed its commitment to covering all medically necessary anesthesia services. This reversal serves as a powerful example of how advocacy from medical professionals and organizations can influence policy and medical billing decisions.

If you’re an anesthesia provider, this incident underscores the importance of staying engaged with industry advocacy efforts. Insurers may continue to propose policies that could affect coverage and reimbursement, and you need to stay vigilant and active in shaping policies that prioritize patient care and safety.

MBM is a partner in these efforts. We keep clients informed of policy changes and help practices respond effectively. From advocating for fair reimbursement to confirming compliance with payer requirements, our billing service company is dedicated to supporting safe anesthesia practices.

(4) Legislative Developments

In response to growing concerns over restrictive insurance policies, a new bill known as the "Anesthesia for All Act" has been introduced in the House of Representatives. 

This proposed legislation seeks to prohibit insurers from implementing arbitrary time limits on anesthesia coverage during surgeries. Instead, the bill mandates that coverage and reimbursement for anesthesia services be determined solely based on medical necessity, as assessed by the attending anesthesiologist.

While Anthem's previously discussed reversal was a victory for patient care advocates, it highlighted a troubling trend of insurers prioritizing cost-cutting measures over clinical judgment and surgeon expertise. 

The "Anesthesia for All Act" aims to set a national standard that makes sure insurance policies cannot compromise patient safety or undermine the expertise of anesthesia providers.

If passed, this legislation could provide much-needed clarity and protection for both patients and providers. It would also eliminate the administrative burden of arbitrary denial management, allowing providers to focus on delivering high-quality care. 

Perhaps most importantly, such legislation would reinforce the role of medical professionals in determining what is truly necessary and appropriate for patient safety during surgeries. 

Medical Business Management is closely monitoring the progress of this change. We understand the cruciality of aligning reimbursement policies with clinical realities. As a result, we’re ready to help anesthesia providers tackle any future changes regarding medical billing processes and documentation requirements.

Possible Implications for Your Anesthesia Plans

The 2025 changes we just listed highlight a mix of hurdles and potential opportunities for anesthesia providers. Adapting to these shifts will require proactive strategies in several key areas, including: 

Financial Planning & Medical Billing

The reduction in Medicare reimbursement rates makes smart financial planning for anesthesia practices all the more important. A 2.20% decrease in the Anesthesia Conversion Factor may seem small at first glance, but for practices with a high volume of Medicare patients, the cumulative impact can strain resources. 

To offset these reductions and protect practice revenue, U.S. providers may need to:

  • Evaluate their payer mix and consider diversifying to include more private insurers.
  • Zero in on cost-effective operations to get paid faster. 
  • Optimize medical billing and coding practices to higher, faster reimbursements for services provided.

MBM helps anesthesia providers juggle these financial complexities. Through our revenue cycle management solutions and billing services, we help practices mitigate their practice’s cash flow while maintaining operational efficiency.

Unlike with in-house billing, outsourcing to experts minimizes errors, reduces administrative burdens, and frees up your team to focus on delivering exceptional patient care.

Quality Reporting

As we touched on earlier, the continuity in MIPS requirements for 2025 provides stability. Anesthesia providers can maintain their focus on quality improvement initiatives, considering steps such as: 

  • Reducing administrative burdens associated with compliance.
  • Encouraging long-term quality improvement strategies for practice performance.
  • Easily integrating data entry and reporting into day-to-day operations.
  • Ironing out the claims process through simple electronic claims.

MBM offers expert guidance in MIPS reporting and medical billing software. We make sure anesthesia practices meet the program's requirements and optimize their potential for incentive payments while minimizing errors.

Advocacy and Engagement

The recent reversal of Anthem’s policy on anesthesia coverage demonstrates the power of the people. Anesthesiologists and their professional organizations played a pivotal role in challenging and overturning an unfair policy that could have compromised patient care. 

By staying informed and involved in discussions throughout this next year, anesthesia providers can help shape an environment that prioritizes clinical judgment and high-quality care. Speak up and stay informed!

In Summary: Protect Your Financial Performance

Don’t face these changes in the medical billing industry alone. At MBM, we have the expertise, strategy, and proactive approach to support you through every evolution in 2025. 

As a trusted partner in tailored medical billing services, we’re uniquely positioned to support anesthesia practices through financial planning, quality reporting, and advocacy guidance. Whether we’re managing your billing needs, submitting claims, or confirming accurate coding, MBM’s services modernize your processes and reduce the risk of claim denials. 

Contact us today to prepare your practice for this and next year’s challenges. Our services will optimize your practice’s revenue cycle and equip you with the latest medical billing solutions.

1025 Montgomery Hwy Suite 100
Birmingham, AL 35216
info@mbmps.comNewsletter Signup
Phone: 205-979-5882
Toll-Free: 800-477-4544
Fax: 205-979-1248
Client PortalPrivacy Policy
© Copyright 2024 Medical Business Management - All Rights Reserved. Website Developed By 
Electro Marketing.