From improving documentation efficiency to educating your staff on new policies, there are proactive steps you can take to ensure regulatory compliance in anesthesia medical billing.
At Coronis Health, we never underestimate the importance of compliance when it comes to anesthesia medical billing. We understand how centralized technology tools that help achieve accurate medical billing and an organized workflow allow you to have confidence in your compliance. Regulatory requirements are complex and ever-changing, requiring your team and any service provider to stay abreast of potential compliance issues.
Below are tips on how to stay on top of regulatory compliance.
Understand the Billing Process for Anesthesia Services
Medical billing for anesthesia services can be more problematic than a surgeon or hospital charges. While accurate documentation is essential to billing, compliance, and reimbursement for every type of healthcare specialty, the process can prove more complex for anesthesia facilities compared to other providers.
Surgeons, for example, only have to use a single CPT code to cover all necessary services from pre-op to post-op. Anesthesia medical billing and coding, on the other hand, is not as straightforward. Anesthesia services are uniquely calculated based on the following criteria:
- 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, remains in attendance caring for the patient, and continues 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.
- Conversion factor – Specific to the provider’s location, this cost is assigned to each unit.
Follow Coding and Documentation Guidelines to Ensure Accurate Billing
To maintain compliance, you will need to:
- Know the correct modifiers – Modifiers refer to the two-character indicators that 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.
- Report qualifying circumstances – If particular services are deemed necessary and reasonable, qualifying circumstances can be submitted to the insurance provider. Compliance improves due to more accurate documentation of the patient chart.
- Append physical status modifiers – These are used for reporting the patient’s overall physical health (ranging from a healthy patient to an organ donor) at the time of encounter or procedure.
- Accurately calculate the time for anesthesia administration – Because anesthesia services must be precise, you must document the exact number of hours and minutes from start to finish. For commercial insurance companies, this is the formula used to report time units for anesthesia services: Base Units + Time + Physical Status Modifier = Total Units
For Medicare: Base Units + Time = Total Units
By being meticulous about documentation and coding, your facility will increase efficiency and compliance in medical billing, resulting in proper reimbursement and an optimized cash flow.
Make Sure Your Staff Is Properly Trained
Billing for anesthesia procedures demands that you are more than just familiar with current requirements. Knowledge is power, as the saying goes. You must constantly educate your staff about regulatory compliance and patient safety goals.
The anesthesia industry, just like other medical fields, is always rapidly evolving –whether in the form of new drugs and devices or approved pain management strategies. You and your staff must keep up with the new guidelines, policies, and patient safety information that go along with these changes, as well as understand and be able to execute what is expected when it comes to processes and documentation. Educate and train your staff to not only stay compliant but to maintain or improve your facility’s organization and efficiency as well.
Use an Automated Anesthesia Billing System to Streamline the Process
You must not only work hard but also work smart. A facility with an optimized workflow runs like a well-oiled machine that enables steady collections while lowering the administrative burden on your staff. An automated anesthesia billing system, in particular, can help streamline all system facets, such as coordinating front and back communication and eliminating lost paper documentation. This allows you to focus on delivering quality care.
When you automate your process, you can bring efficiency to the system so payments are made in a timely manner, while minimizing errors and denials and improving your cash flow.
If you utilize an Electronic Health Record (EHR) system, for example, you can simplify your facility’s workflow. Improving tasks, such as scheduling, coding, billing, and payment processing allow you to improve efficiency and meet your revenue goals.
A cutting-edge billing system also updates regulatory changes and contains relevant compliance requirement information that is useful to your facility.
Stay Up-To-Date on Changes in Reimbursement Rates and Other Billing Regulations
Remain updated with all HIPAA policies, guidelines, procedures, and new anesthesia codes in medical billing to avoid claim denials –even fines and lawsuits.
The law is complex and remaining compliant requires regular review and education. Managing compliance is also an around-the-clock endeavor. Facilities must always be vigilant to address ever-changing regulations, improve healthcare quality and safety, mitigate risk, enable accurate billing and coding, ensure timely reimbursements, and keep patients safe.
Regularly Audit Your Anesthesia Billing Records to Ensure Accuracy
An audit will examine your current processes and performance, covering all facets of anesthesia medical billing services, from medical coding and patient eligibility verification to claims submission and denial management practices. An audit evaluates records and processes to identify areas requiring improvement or special attention.
Regular auditing will help educate your staff on regulatory compliance. And when everyone follows proper procedures with accuracy, you can better achieve your goal of efficiency, optimized revenue, and safe, high-quality patient care.
Questions about Anesthesia Billing Services? Contact Coronis Health Today!
A compliant facility is an empowered one. If you’d like to learn more about how you can stay fully optimized and compliant, contact Coronis Health to request your free financial checkup today.