We understand the complexity of Anesthesiology, let us build your business.
Medical billing for Anesthesiology greatly differs from other forms of billing that clinics and hospitals might face with strict, federal guidelines.
The ongoing changes in the healthcare environment have necessitated that a billing team have dedicated and prompt follow through on denials and no claim responses. Even though our focus is on medical billing and accounts receivable management, our broad experience across the entire Revenue Cycle Management process in an Anesthesiology practice is why we can give you an advantage compared to in-house billing.
Billing for anesthesia services has many challenges that often times have less than optimal results and
lower revenue. Our highly experienced team at Etransmedia has the knowledge and skills necessary to successfully provide our anesthesiology customers the right practice management services that will reduce A/R while streamlining revenue and increasing your practice’s collection rates. We know how important it is to get paid fast!
What we know…
No other specialty has the time and modifier pricing components and cross referencing to anesthesia codes. No other specialty has the inconsistencies with the payers as far as the claim formatting they require. Some payers want units billed, others total minutes. Some payers want the CRNA charges billed separately while some do not.
Factor in modifiers, add-on code use, and conversion factors for proper reimbursement. Here are some tips:
You should report a P modifier whether or not the insurance carrier pays for them. Providers should use the same classification. The physical status system is used to describe the patient’s current risk for surgery.
P1 A normal healthy patient
P2 A patient with mild systemic disease
P3 A patient with severe systemic disease
P4 A patient with severe systemic disease that is a constant threat to life
P5 A moribund patient who is not expected to survive without the operation
P6 A declared brain-dead patient whose organs are being removed for donor purposes
Cancelled prior to induction: You may still be able to get paid for your time. If the surgery is rescheduled for more than two weeks after the cancellation you may be able to bill an E/M service. Insurance carrier policy will dictate appropriate time between cancellation and rescheduled dates as well as if you can use a consult code or a visit code. Document reason for termination, services actually performed and time spent giving pre-op care.
Cancelled after induction: Utilize modifier 53 (Discontinued procedure). Documentation must include reason for discontinuance, services actually performed, time spent on pre-op, operative and post-op care, procedure that was to be performed.
Postoperative Pain Management:
Usually postoperative pain management is done by the surgeon and is included in the global surgical package. However a surgeon may request that the Anesthesia Service manage the patient’s postoperative pain (surgeon needs to document in the patient’s medical record why referring the post-op management to the anesthesiologist is necessary).
Ideally, a separate procedure report for the post-op pain management procedure should be written. While writing separate reports isn’t absolutely necessary, it might help the payer better understand the situation – which can speed up reimbursement.
An epidural or major nerve injection or catheter insertion performed by an anesthesiologist for postoperative pain management (and not used for anesthesia for the procedure) before, during, and/or following the surgical procedure is eligible for separate reimbursement in addition to the primary anesthesia code. You may append modifier 59 (Distinct procedural service) or one of the new X modifiers to the appropriate procedure code to indicate a distinct procedural service was performed.
On October 1, 2016 the Centers for Medicare and Medicaid Services (CMS) will no longer accept unspecified codes in most cases.
Starting in October, CMS requires greater specificity for claims filed in ICD-10-CM/PCS. The 12-month grace period originally introduced in 2015 said they would not deny claims for lack of ICD-10 specificity. That all changes on October 1, 2016. Payors will most likely follow suit if they haven't already.
First Pass Clean Claim Rate
Boost in Revenue*
Reduction in Cost*
The matrix of all the criteria is complex and to some billing offices it can be daunting. At Etransmedia we have a front end editing system built from years of experience and research that knows how the particular payers want all of the above on the claims we submit and we make sure that information stays current with the payers’ (and the ASA’s) criteria. That way the claims are filed correctly, saving reworking and resubmitting and speeding up cash flow. Don’t trust your anesthesia billing to inexperience, trust Etransmedia to do it right the first time.
Although the new industry standards can be confusing and difficult to navigate, our dedicated team here at Etransmedia can assist in guiding you and helping to make your practice grow successfully.
*Please Note: Results are not guaranteed, implicitly or explicitly, and will vary based on several factors such as individual practice demographics, specialty, payer mix, operations, and management among others
Service and Technology Packages
Our customizable revenue cycle management service and technology solution packages allow you to outsource based on the specific needs of your practice
Silver RCM Service
This package has the core service and technology needed for revenue management allowing you maintain the responsibility of patient billing.
Gold RCM Service
This package includes the core RCM services with added denials, A/R management services, and full service patient billing
Ancillary RCM Services & Technology
Available to enhance any package