Skip to main content

Anesthesia Medical Billing RCM: What to Know

October 4, 2022

Adhering to the medical billing rules and guidelines specific to anesthesia care is required in order to accurately report anesthesia services and get reimbursed in a timely manner. Anesthesia medical billing can be complex and time-consuming, which is why most facilities choose to partner with a medical billing company to achieve a more efficient workflow, prevent denials, and ensure maximum reimbursement.

What Is Anesthesia Billing and Revenue Cycle Management (RCM)?

Anesthesiology is the medical specialty concerned with the total perioperative care of patients before, during, and after surgery. Its key aspect is the use of anesthesia and anesthetics to safely support the patient’s vital functions through the perioperative period.

There are different types of anesthesia providers, such as anesthesiologists, certified registered nurse anesthetists (CRNA), and anesthesiologist assistants (AA). Each will bill separately for their professional services, just as surgeons and other physicians bill for their services rendered.

Medical billing for anesthesia can become a complicated process, as it requires documenting several records, including:

  • Pre-operative review
  • Anesthesia sheet
  • Post-operative review

The success of a facility that provides anesthesiology services relies on its ability to generate and collect revenue, and an integral element of a seamless anesthesia billing process includes efficient revenue cycle management.

Revenue cycle management (RCM) is every step of the claim lifecycle. It works at the functional core of a healthcare organization as it covers the entire spectrum of a facility’s operations, from front desk and scheduling, eligibility verification, care delivery, documentation, anesthesia medical billing and coding, and claim processing. The main goal of RCM is to optimize the profitability of a healthcare facility by automating manual processes and reducing the costs of making collections.

The Benefits of Working With an Experienced RCM Company for Your Anesthesia Medical Billing Needs

Implementing efficient revenue cycle management is an invaluable component of your facility’s success. By partnering with an experienced RCM company, you gain the following advantages:

  • Optimized workflow – With automated processes, you can bring efficiency to your system, and payments can be made much faster. This means minimizing errors and denials while maximizing cash flow. An electronic health record (EHR) system, for instance, can simplify your facility’s workflow. By improving tasks such as scheduling, coding and billing, and payment processing, you get to achieve a more effective and efficient system that saves you time for non-administrative tasks like caring for your patients.
  • Streamlined processes – A facility that runs like a well-oiled machine will not only ensure consistent collections that make your facility financially viable but will also lessen the administrative burden on your staff. An electronic workflow can help streamline all system facets, such as coordinating front and back communication, concluding a patient’s journey with timely payments, and eliminating lost paper documentation. 
  • Enhanced patient experience – A skilled RCM team coupled with the right technology will contribute to an efficient process that minimizes standard billing and coding errors. This means simplifying the process and improving all the touchpoints involved in your patient experience. A streamlined process reduces unnecessary stress and results in higher patient satisfaction.
  • Improved claim scrubbing – Denials are the result of payment claim errors. Optimized revenue cycle management brings accuracy to your facility’s system, leaving little room for mistakes. By getting coding right the first time, you get to reduce claim denials and receive your reimbursements faster. 
  • Faster collection process – With the right set of software solutions and automation tools, all the time-consuming tasks such as data collection, insurance verification, and coding will take significantly less time compared to doing them manually. By automating each step of the cycle, from eligibility checks and payment follow-ups to data charge entry, you can expedite the entire process. 

The Most Common Challenges With Anesthesia Billing and Reimbursement and How an RCM Partner Can Help Overcome Them

coronis health anesthesiology medical billers shaking hands

Anesthesia billing is more complicated than billing for most other medical fields. Between time units, modifiers, and other anesthesia codes in medical billing, it can be challenging for facilities to understand how to manage these complexities and still maximize revenue. Below are the components of the general formula and unique features used for calculating anesthesia charges:

  • Base units – These reflect the complexity of the surgical procedure. Each procedure has a corresponding code with a base unit value. More difficult procedures that require a higher skill level will have a higher base unit. 
  • Time units – A time unit is usually 15 minutes in length, but the valuation can change by contract. Time accrues while the physician assumes patient care, and remains in attendance caring for the patient until the patient is no longer under their care, and the report has been completed.
  • Modifying units – Emergencies and certain conditions in a patient’s health are considered modifying units. Modifiers are indicators that will help identify relevant details on a claim. Accurate usage of modifiers will help ensure proper claims payment. Modifiers also help avoid duplicate billing and unbundling.
  • Contracted rate – This rate refers to the contractually agreed upon amount between the anesthesiologist and insurance provider.

To ensure proper reimbursement for anesthesia services, billers must include:

  • Number of minutes of anesthesia administration
  • Procedure anesthesia codes (00100-01999)
  • Modifiers (e.g., modifier codes for physical status) 
  • Proper identification by including any performing provider(s) NPI on the claim form.

The best way to leverage these challenges in billing is to partner with an experienced anesthesia revenue cycle management company. This means having access to billing expertise that will help reduce risks of errors, claim denials, and delays.

Your RCM partner will have certified medical billers and coders who understand the regulations that govern how insurance payors reimburse and how facilities must document to receive reimbursement. They are trained on how to apply coding that correctly correlates with clinical documentation and are consistently updated on any changes that apply to coding or billing procedures. 

Outsourcing your medical billing ensures that you are working with a team that focuses 100% of their time on the revenue cycle. You will see an improvement in compliance, as your outsourced billing is following the guidelines and regulations set forth by the government and CMS. 

Finding a Reputable Revenue Cycle Management Company for Your Anesthesia Medical Billing Needs

If you find your medical facility is putting more time into collecting bills than into actual care of your patients, it may be time to update your revenue cycle management solutions.

Here’s what to look for when choosing a reputable RCM company:

Expertise in Anesthesiology 

Different specialties come with unique billing and coding challenges. This means it is important to find a medical billing company that has coding expertise in anesthesiology. Failure to go with a company that has expertise in your specialty may result in coding inaccuracies and claim denials that make it more difficult for you to reach those bottom-line goals.

Services You Need

Revenue cycle management should be handled by experts who are familiar with all aspects of anesthesia medical billing services. You must identify your expectations about which tasks you want to oversee in your facility and which services you want the billing company to provide. 

Long-Term Partnership Potential

Ideally, you will not switch RCM partners often. You need to know if that partner will be there for the long haul. Some of the most important things to know are if the partner will provide phone support for your in-office hours and what sort of issues are handled by the partner. 

Transparency of Data

Will your staff have all access to records that are transferred into the medical billing system? The right partner will give you real-time access to any information that you are looking to review. 

Your facility’s financial health depends on the quality of your RCM partner – do your research and choose a company that is not just a business partner, but also a team member who truly understands your facility’s mission and vision to offer the best services to your patients. 

How an Outsourced Billing Service Like Coronis Health Can Streamline Your Anesthesia Billing and RCM

Coronis Health will look at every portion of your billing process as an opportunity to increase revenue by identifying and then correcting the root cause of any problem. We understand how medical billing and collections are critical to the survival and growth of your facility, and patient collections can become a daunting task for your staff. 

We believe that behind every successful facility is a robust practice management and billing software system. Our financial team will analyze your current system, go over your organization’s objectives and concerns, and then determine the best options for streamlining your anesthesia billing and other processes to achieve more efficiency and give your revenue a boost. 

Coronis Health will provide tailored and flexible solutions to meet your facility’s needs. With 35+ years of experience, our experienced consultants understand the importance of working down AR. As technological innovators, we utilize the latest software and employ actionable intelligence so we can assist you in getting your AR under control and most importantly, get you paid.

Let’s Work Together To Build the Best Revenue Cycle Management System

Would you like to increase your revenue, reduce denials, and accelerate your cash flow? Contact Coronis Health to learn more about how our data-driven solutions can help optimize your revenue cycle. You may also request your free financial checkup today.

Get the Latest RCM News Delivered

Receive practical tips on medical billing and breaking news on RCM in your inbox.

Get in Touch