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December 29, 2015

The Increased Need for Negotiation in Anesthesiology Billing

December 29, 2015

anesthesiology billing

Negotiation may play more of an active role in bundled payments, one of the fastest-growing models of anesthesiology billing in the industry today.

Here’s more on the role of negotiation in bundled payments in anesthesiology billing.

Bundled Payments and the ACA

Payment for services rendered by anesthesia providers fall into one of six categories:

  1. Fee-for-service (without gain sharing)
  2. Discounted fee-for-service with potential gain sharing
  3. Percentage of bundled payment
  4. Portion of shared savings
  5. Bonuses for quality and/or performance metrics
  6. Withholds and risk pool participation


While fee-for-service is still the dominant form of payment for services in the anesthesiology field, bundled payments have been more prominent as the result of healthcare reform under the Affordable Care Act. They form a middle ground between fee-for-service and capitation (being paid a lump sum per patient, regardless of services rendered).

Under the ACA, though, negotiation is going to play more of a role in payments, which means practices need firm data on which to base the value of their services to ensure they get fairly compensated.

Establishing Value for Negotiation

Practices need to establish a basis by which to evaluate proposals. This means looking at the cost of providing specific services, examining what usual fee-for-service payments are for services that are similar, and calculating the bottom line – what you’ll take at a minimum – for a procedure.

Add to this calculation profit margin, risk margin, and upside gain should your team achieve savings. An examination of the practice’s costs, revenue and individual data can help determine a baseline that can be used in negotiations.

One challenge is for the anesthesiology provider to explain and demonstrate the value of their services to physicians who may be reluctant to share payments with other practices. There are many benefits, ranging from postoperative pain management, fewer inpatient days, and increased satisfaction scores from patients.

Refining Your Anesthesiology Billing

Negotiations for bundled payments will take center stage under ACA. It is important for your practice to be prepared.

Further prepare yourself by outsourcing your anesthesiology billing to a trusted third-party provider of billing services, to save money, increase profit, and cut costs. Contact Medical Business Management for more information.


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