Critical Anesthesia Billing Areas

  • Anesthesia coding is more complex than most specialties. Since anesthesiologists perform their services in the operating room, anesthesia billing can involve thousands of codes versus the 15-20 frequent codes in other specialties, necessitating a specially trained coding team

  • Reimbursement depends on the combination of type of provider, time spent, and patient's current and past condition. Incorrectly capturing these details frequently leads to revenue leakage. Capturing these details correctly can significantly increase reimbursement

  • Anesthesiologists can medically direct and obtain full payment for up to four concurrent cases. Even a single minute of overlap on a fifth supervised case can cause CMS to decrease payment in all five cases. If the right system of checks and balances is not employed, the end result can be fraudulent billing and substantial overpayment.

  • Medical direction occurs when a physician anesthesiologist works with one to four other qualified providers in overlapping cases. If more than four cases overlap, even for a single minute, this is considered to be medical supervision. Most payers will not reimburse the anesthesiologist for this service. When these tasks aren’t documented as having been finished, billers with insufficient anesthesia experience often inaccurately file claims as medically directed.

  • Modifiers are added to the procedural code while billing. Modifiers such as physical status, age and emergency factors may be added to the procedure code. The total number of units is then multiplied by a conversion value to create a total charge for the procedure. When billers are not fully aware of modifier usage, the result can be inappropriate billing and overpayment/underpayment

  • According to CPT guidelines, billing time for Anesthesiologists is the exact time in minutes that the doctor spends with the patient in preparation and administration of the drug. Recording and reporting discontinuous time spent by the Anesthesiologist, wrongly billing time when patient is in holding area are major cause of errors causing revenue leakage.- This is watched closely by the Medicare Recovery Audit Contractor (RAC) program.

Fedora's approach to anesthesia billing

  • Owing to the complexity of anesthesia billing, a rigorous underpayment analysis is critical to ensuring all revenue is captured and the payer is not underpaying on their contracted rates.

  • File claims in an accurate and timely fashion. Fedora utilizes a triple review of claims prior to submission to prevent billing errors from causing denials. Fedora also submits charges within 24 hours of receipt to accelerate the revenue cycle.

  • Increase patient collection rate. Since most patients only have an indirect relationship with anesthesia provider, collections from patient statements have limited success. Fedora's processes in benefits verification are designed to enable the front desk to collect the patient responsibility when the patient is physically present.

  • Assist the practice in payer negotiations by maximizing the usage of data points to have better renegotiation results for the practice.

  • Stay educated with payer behavior changes. Payer behavior in anesthesia has had more changes in the past 4-5 years than most specialties, and staying informed is critical to billing success.

Fedora has experience with billing for diversified sources of revenue for anesthesiologists in pain practices

Our experience can help practices explore nontraditional avenues of revenue, including:

  • Utox

  • DME

  • Chiropracty

  • PT

  • Occupational Care

  • Functional Evaluation

  • CSR

  • EMG/NCV

  • TM Flow

Critical Anesthesia (Pain Management) Billing Areas

Fedora's reconciliation and claim scrubbing processes address all of these critical areas:

  • Avoid billing multiple initial levels

  • Avoid billing for more levels then performed or vice versa.

  • Avoid under billing for contrast/drugs

  • Capturing waste billing in entirety

  • Capturing supplies billing in entirety

  • Maintenance of uniformity while coding/billing

  • Ensure proper usage of modifiers (especially 59 & 25)

  • Ensure that all visits/procedures are being captured

  • Use of current codes

Fedora is up-to-date on all changes in billing procedures

  • Regularly update providers on amendments and changes in local carrier medical policy

  • Ensure proper documentation for procedures and E/Ms to avoid any compliance failures.

  • Pay meticulous attention towards documentation of sensitive procedures like Epidurogram, a prime audit trigger for pain management practices.

  • Monthly audits of coding and reconciliation