Medical billing for anesthesia services can be more complicated than common healthcare claims because anesthesia is billed and coded separately from the procedure itself. This unique characteristic of anesthesia billing leaves room for errors. The complexities of anesthesia billing should be carefully considered to avoid denials or delayed payments. Errors in the billing process can also lead to unmanageable bills for patients, which can diminish your facility’s reputation.
How can you make your anesthesia billing process more efficient? Let’s elaborate on five common mistakes you should avoid when billing for anesthesia.
Not Understanding the Anesthesia Billing Process
Billing for anesthesia is significantly different from more common claims. Anesthesia charges are calculated very carefully and precisely based on the difficulty of the procedure, time, and modifying factors, like the patient’s state of health.
If your team doesn’t understand how these calculations are made, your bill could wind up much higher or lower than it should be, and insurance companies will scrutinize these mistakes. To maximize revenue from anesthesia services and avoid delays, the claims process must be smooth and error-free.
Secondly, government-issued and private insurance policies have different compliance regulations regarding anesthesia medical billing. Your billing professionals must be aware of these differences and be up-to-date with recent changes in regulations.
Incorrectly Coding Anesthesia Medical Procedures
Coding errors can also cause problems in anesthesia billing. Each procedure has a different set of codes and modifiers, and errors lead to denied claims. Your staff should be knowledgeable on the codes and modifiers for different anesthesia medical procedures for accurate anesthesia billing.
There are three types of procedures for anesthesia:
- General
- Monitored Anesthesia Care (MAC)
- Total Intravenous Anesthesia (TIVA)
Additional codes and modifiers are added to define exactly what procedure was performed and under what circumstances. This helps insurance companies understand why a certain volume of anesthesia was given, so they can determine if it was used for a critical situation.
Additional and modifying codes should be added for patients who meet certain criteria, such as patients less than one-year-old, more than 70 years old, or a patient who has a systemic disease. If your coders aren’t knowledgeable about the different types of anesthesia procedures and their modifiers, it can lead to denials and lower reimbursement.
Failing to Follow Up on Unpaid or Denied Claims
Healthcare facilities are busy focusing on patient care and don’t have the time or resources to fully understand the complexities of anesthesia billing, let alone follow up on denied claims.
However, anesthesia services can get pricey, which means insurance companies will scrutinize errors in the billing and coding process. When an insurance company denies a claim, it’s important to follow up to ensure no mistakes were made. If an error occurred, your team should work to resolve it to avoid revenue loss.
Billing for Services Not Provided
Billing for services not provided is a big mistake, and it can even lead to legal issues. If your team doesn’t properly capture the anesthesia services provided or overbills for the services, you’ll see substantial disruption to your claims process, and eventually, your revenue cycle.
Oftentimes, overbilling is simply due to a misunderstanding in the billing and coding process. For example, anesthesia procedures must be recorded and charged to the particular minute, and rounding up can lead to a denied claim for billing for services not provided. If your medical billers and coders aren’t knowledgeable on the nuances of calculating anesthesia charges, they could accidentally overcharge a patient significantly, and the claim may be denied.
Not Using an Anesthesia Billing Specialist
The nuances of anesthesia billing call for a specialist to avoid errors that can cost your facility. The difficulties of calculating charges, correctly coding, and adding modifiers are best left to an expert for approved claims and quick reimbursement.
Your practice’s profitability depends on your ability to collect payments. Outsourcing anesthesia billing and coding to a trusted company is the ideal solution to avoid mistakes and maximize your revenue cycle. Without the pressure of complex anesthesia billing and coding, your team can put the focus back on patient care.
Coronis Health is a reputable revenue cycle management company offering comprehensive medical billing and coding solutions, including anesthesia medical billing services. Our billing and coding experts use ideal medical billing software for anesthesia and are knowledgeable in the nuances of anesthesia billing calculations, coding, and modifiers.
We have a high rate of successful claims, and those for anesthesia are no exception. If you’re looking for anesthesia billing services to help you get the most revenue back and hit your financial targets, contact Coronis Health today to get started.