In the simplest terms, inaccurate anesthesia coding and billing cost money. Revenue cycles are difficult enough in a healthcare landscape that is facing a budget crisis. The anesthesia conversion factor for 2024 has fallen to $20.4349 from $21.1249 in 2023. Coupled with an increased demand for anesthesia services, most practices simply can’t afford to leave any money on the table.
Anesthesia is the most complicated of medical billing, so it’s not simply a matter of just filling in the blanks. Even with proper training in anesthesia coding and billing, there are many common mistakes most practices make. These mistakes cause a ripple effect starting with lost revenue and ending in poor patient care. Let’s take a look at the common mistakes to avoid in anesthesia coding and billing.
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The Problem - Inadequate Documentation
Anesthesia practices that do not sufficiently document their procedures will become very familiar with denial code #130. Thorough, detailed, and precise documentation is the foundation on which a successful revenue cycle is built. It will reduce time spent addressing claim denials and secure every dollar of reimbursement due. Following a documentation checklist every time with every procedure will confirm the correct documentation of the anesthesia services provided.
Make sure your documentation:
- Is for the correct beneficiary
- Verifies the beneficiary’s insurance
- Is for the correct date(s) of service
- Contains accurate start and stop times
- Contains a valid and legible signature
- Clearly documents the reason for the care
- Contains details of the procedure, operative, and anesthesia reports
- Shows evidence of continuous monitoring of the patient’s oxygenation, ventilation, circulation, and temperature (when applicable)
- Shows a post-anesthesia evaluation of the patient, including status on discharge
The Solution - Comprehensive Documentation Practices
It’s difficult to remember the details of an event after the fact. Anesthesia providers who wait to document procedures will forget to include specifics that can be the difference between a denial and an acceptance. Having a system in place will encourage timely and thorough documentation to become second nature to anesthesia providers and staff. Even with the best documentation practices and training, however, anytime you can convert a manual administration process into an automated one saves your practice money and helps with accuracy. Electronic Health Records (EHR) systems are an industry standard to securely track patient information and insurance claims. Utilizing software strategically in your revenue cycle helps eliminate mistakes and redundancies and saves time.
The Problem - Improper Coding
Coding is not easy. Anesthesia coding systems are the most complex in the healthcare system. Charges are calculated according to the difficulty of the procedure, the level of anesthesia administered (General, MAC, or TIVA), service time, and modifying factors like the patient’s state of health. Proper coding involves an intimate understanding of the procedures performed and an encyclopedic knowledge of CPT codes. The consequences of incorrect coding are more claims delays and denials, revenue loss, fines and penalties, a loss of trust, and poor patient care. The hardest part of your job should be in the operating room, not in the paperwork.
The Solution - Training and Education
Anesthesia coding isn’t something that is set in stone - codes change as technologies and procedures change. Therefore, ongoing training for anesthesia coders is an important investment in your revenue cycle. Becoming a coder takes one to three years of professional training as well as 36 continuing education units (CEUs) every two years to stay CANPC certified. We recommend conducting an audit of your coding and billing practices at least yearly. This annual ‘spring cleaning’ ensures consistency among coders and across procedures.
Don’t want to spend time and money training staff? MBM has the know-how to handle your revenue cycle and put money back in your pocket.
The Problem - Misunderstanding of Insurance Policies
Understanding insurance policies means navigating the specific rules, coverage limitations, and pre-authorization processes for different insurance companies. Insurance companies are trying to pay as little as they can while still fulfilling the terms of their contract, so they are looking for any excuse to deny or reject a claim. In addition, anesthesia coders must stay on top of CMS changes and federal legislation. It’s a lot to keep track of! But the consequences are like those for other mistakes in the revenue cycle - a loss of money and a decrease in your practice’s standard of patient care.
The Solution - Communication with Insurance Providers
The revenue cycle team is not just your practice’s in-house billers and coders, but also the insurance providers handling your claims. Communication with these providers can help you understand why a claim got denied and expedite the process of resolution. This will also increase patient satisfaction as payment responsibilities are addressed upfront instead of after the procedure. To stay current, you must monitor changes in insurance policies from the federal government as well as from CMS. Spending time reading industry news can be a valuable tool to keep your billing and coding knowledge ahead of the curve.
The Problem - Failure to Identify Patient Eligibility
Anesthesia billing and coding is not just a set of activities that happen after the patient has healed; they start the moment the patient books a visit to the physician’s office. Failing to verify a patient’s insurance coverage upfront can create bills that don’t accurately estimate a patient’s financial responsibility. This can lead to nasty surprises which lower patient satisfaction and delay claim approval and reimbursement. Relying on an entirely manual billing system has its consequences. Even a simple mistake like transposed digits in a patient’s insurance ID can lead to the denial or outright rejection of a claim. So, patient eligibility should be a priority on your billing procedures checklist.
The Solution - Insurance Verification Protocols
Before a procedure is performed, you must verify if the patient is eligible for the medical service if the insurance is valid, and what benefits the insurance includes. This involves gathering and verifying essential information, such as the patient’s insurance ID, the policy number, the coverage period, any co-payment requirements, deductibles, and pre-authorization requirements. Establishing a protocol for all the steps in the billing process, including patient verification standards, is highly recommended. If you are utilizing a billing software in your process, it’s possible to streamline insurance verification with automated data retrieval and real-time eligibility checks.
Not sure about billing software or how it works with your revenue cycle? We can help!
Benefits of Meticulous Billing
In addition to the issue of revenue, there is the issue of compliance. Instead of under-coding, here you must look out for over-coding. CMS holds you personally responsible for anything filed under your NPI number. Even if it’s accidental, fraud is a serious issue, and you can’t risk your anesthesia practice’s integrity coming into question.
Most of the time, billing and coding mistakes aren’t due to malice or negligence, but are simply due to a workflow without checks and balances. According to a study presented to the ASA, an analysis of 40,312 procedures involving anesthesia at a surgical center that occurred between November 1st, 2021, and October 31, 2022, showed that the incorrect calculation of AST (Anesthesia Start Time) led to a loss of $638,671.57 in revenue for the year. Could your practice stand to lose out on over half a million dollars?
