From a medical billing point of view, anesthesia practice falls into three categories i.e., time-based surgical anesthesia, obstetric (OB) anesthesia, and non-time-based charges, such as those for invasive monitoring, nerve blocks, ultrasonic guidance, and visit codes. It is payment for obstetrical anesthesia that confuses and frustrates the most because of complex, diverse and inconsistent billing rules.
The effective management of a profitable obstetric anesthesia service is more complicated than the surgical anesthesia service. Obstetric anesthesia is either a make-or-break service for any anesthesia practice. Many practices have lost their contract as a result of their unwillingness to provide a comprehensive service. So, let’s take a look at unique billing challenges offered by obstetric anesthesia medical billing:
Challenges for Obstetric Anesthesia
Calculation of Time
The key challenge is the determination of time units for obstetric anesthesia billing. Payer policies require the documentation of actual time spent with the patient while anesthesia providers feel they should be paid for the time they are available.
Diverse Payer Policies
Diverse payer policies are a critical factor. The goal is to ensure appropriate payment. Usually, the Medicaid policies are the most specific, even though the rates are the lowest. Every state Medicaid policy for obstetric anesthesia is different.
Price setting for any medical service is a juggling act. On the one hand, the objective is to price the service so that it is not underpaid, which would result in leaving money on the table. On the other, pricing must be sensitive to market factors. The average time units can be as high as 29 or 7.25 hours. This will result in substantially high bills, some of which will be higher than the obstetrician’s charge.
Percentage of Medicaid Patients
The most important single factor in the profitability of an obstetric anesthesia service is the percentage of Medicaid patients. In almost every state, Medicaid has the lowest payment rate while maintaining the most stringent payment requirements. A practice with overwhelming Medicaid will find it very difficult to generate enough money to cover the cost of providing the service.
As an Anesthesiologist, you are well aware of the special requirements needed to bill for services you render. The work of an Anesthesiologist, in fact, starts during the pre-surgical phase when they determine the drug and the amount to be given based on the history of the patient. We have the prerequisite knowledge and expertise to ensure that your billing captures all services thereby providing for more efficient and effective collections. For more information on anesthesia billing and coding, please get in touch with us!