Anesthesia Billing is unlike most specialties as it is more complicated and requires expertise and appropriate tools.
Our billers and coders are certified and trained continuously to keep up with the changes in codes, rules and regulations. We also use the latest and most appropriate software tool for anesthesia billing.
For anesthesia billing to be accurate, coders and billers should be well acquainted with
- Different modifiers and how to use them to prepare and submit clean claims.
- Qualifying circumstances. Documentation relating to qualifying circumstances can be submitted to the payor if the services rendered are considered acceptable and needed. These additional codes can mean higher payment for the anesthesiologist or CRNA.
- Physical status modifiers. These are used for declaring the physical health of a patient at the time of a procedure. This can increase the profitability of your facility.
- Calculation of base units
The cost of an anesthesia service is calculated based on the following parameters:
- The difficulty of the procedure
- Modifying factors such as the health of the patient
The general formula is:
Anesthesia charge = (Base units + Time units + Modifying units) x Conversion factor
Base unit: Every anesthesia procedure has been assigned a code which has a base unit value. The base unit value indicates the difficulty and skill required for the procedure.
Time unit: Each procedure takes a certain amount of time. A time unit is generally 15 minutes in length but maybe 10-12 minutes, depending on the location.
Modifying unit: A modifying unit takes into account special conditions such as the patient's health/emergencies that affect the anesthesia plan and administration.
Conversion factor: This is the cost assigned to each unit and is specific to the location of the anesthesia provider administering the anesthetic care. This cost will vary across the United States.
Anesthesia billing claims can be denied by payors for various reasons, the major ones being
- Inappropriate Bundling
- Medical Necessity
- Prior Authorization
- Request for Supporting Documentation
- Time rounding & other underpayment scenarios
Our coders and billers will ensure that clean claims are submitted and denials kept to the minimum. They will also ensure that there are no underpayments and that you are reimbursed to the maximum as per your contracts.
Talk to us! We are here to take care of your Anesthesia billing worries.
CALL + 1 (800) 253-7320 or click here we will call you.