The specialty of anesthesia is not unlike a tall ship sailing steadily at sea. Groups will have to successfully navigate a few compliance-related challenges in 2026 if they want to get through the year undaunted and unscathed. Shifts in reimbursement policy, changes in state-level laws and regulations, and updated safety and facility standards are just a few of the difficulties with which today’s anesthesia practices must contend. These issues, after all, affect how anesthesia groups bill, staff, document and practice from a patient care perspective.
With that in mind, let us now take inventory of some of the more pressing compliance issues that could create a few waves for the average anesthesia group.
Pressure from Payers
Some health plans are amping up the pressure on anesthesia practices by publishing policies that make it more difficult to reap reasonable reimbursement. According to one source, these policies “would require groups to maintain accurate credentialing and network status, strengthen documentation for medical necessity and closely monitor payer‑specific billing rules to avoid penalties.”
According to certain leaders within the surgery center community, payers are becoming increasingly “creative” and, indeed, “aggressive” in their tactics when it comes to delaying anesthesia payments. Katy Dean, a CRNA and chief nurse anesthetist in Newport News, Virginia, provided her take on what’s happening in this regard:
We’re seeing more denials for time discrepancies, claims being reprocessed months later with money pulled back, and even outright rejections for technicalities. For example, if I do a regional nerve block for pain control after surgery, insurers often say that’s included in the anesthesia charge, when it’s not. That block requires separate expertise, time and documentation.
CRNA Dean also went on to point out the problems she is now encountering as it concerns prior authorization:
Prior authorization is becoming a major barrier, too. Even for routine procedures or pain management, insurers are demanding approvals in advance; and, if you don’t jump through their hoops, they’ll deny the claim after the fact, regardless of medical necessity.
Seeing obstacles placed in the path of provider reimbursement by commercial and other payers has been well documented by our previous articles and alerts. But it does seem that there is a ramping up of this trend, and it will behoove providers to be more focused on ensuring compliance with these ever-changing and increasingly constricting payer policies.
Changes in State Law or Regulation
Multiple states are revising or clarifying rules that directly impact anesthesia practices. Here are a few examples:
In 2025, several states introduced new laws that impact anesthesia practice, particularly for certified registered nurse anesthetists (CRNAs). Here are some of the key updates:
- In California, legislation was introduced that would clarify CRNA regulations, addressing workforce challenges and ensuring quality care without disruption.
- In Florida and Virginia, lawmakers introduced measures that would grant CRNAs the ability to practice without physician supervision, including admitting, managing and discharging patients.
- Legislatures in Washington, New Jersey, Illinois and Missouri introduced bills that would ban time caps on anesthesia coverage, preventing providers from denying coverage or capping reimbursement based on the duration of anesthesia used. All these were in response to Anthem's failed attempt to impose time-based reimbursement limits.
These legislative actions highlight the importance of anesthesia providers keeping track of what’s happening within their own states so that they can stay aligned with rapidly changing local laws. Coronis Health is your partner in this endeavor, providing timely alerts when such changes arise.
Clinical and Quality Compliance
New analgesics and anesthesia‑adjacent medications introduce compliance needs around updated formularies, staff education and monitoring for safety and efficacy. As drugs evolve, anesthesia practices must ensure protocols reflect current FDA approvals and safety data.
In addition, federal quality programs (MIPS and other accountability models) increasingly tie reimbursement to accurate reporting of anesthesia‑related quality metrics, as well as demonstrated adherence to perioperative safety standards. The American Society of Anesthesiologists emphasizes that quality reporting now offers benefits beyond simply meeting federal requirements, meaning compliance is both regulatory and strategic.
So, it’s not getting easier. Regulations and rules are constantly changing, and anesthesia practices must stay up to date in order to optimize reimbursement and avoid the shoals of adverse consequences. Coronis Health remains committed to providing guidance and assistance when it comes to the changing currents in anesthesia compliance.