Basics of Surprise Medical Billing
Out-of-network billing, or ‘surprise medical billing,’ occurs when a patient receives a bill for the difference between the out-of-network provider’s fee and the amount covered by the patient’s health insurance, after co-pays and deductibles. These bills can be unanticipated by patients, who often assume that facility-based providers, including anesthesiologists, are in-network because their surgeon and hospital are in-network.
Surprise medical billing has affected one in five Americans, amounting to $40 billion each year. The problem can be caused by health insurance companies who create narrow networks of healthcare professionals, limiting patients’ access to in-network physicians. Insurance companies may seek to improve their profitability by refusing to negotiate fair payment rates with anesthesiologists and other physicians.
Although 90 percent of anesthesiologists’ claims are in-network, meaning patients don’t receive surprise medical bills, there is still cause for concern. Some patients still face financial harm from surprise medical billing, often due to circumstances beyond their control.
Surprise billing is not only a problem for patients, aggressive health insurance companies also harm physicians’ practices as well. Anesthesiologists must maintain the ability to negotiate fair payment rates and resolve disputes in a fair and balanced way in order to keep their practices healthy.
Preventing Surprise Medical Bills
Coverage report:
The easiest way to prevent surprise medical bills is to determine eligibility for major procedures as far in advance as possible. Most of the time, front-end revenue cycle teams are only able to work 2 to 3 days out to obtain prior authorization from insurance carriers for services like surgery, which leads to a scramble and creates headaches like unexpected, out-of-network charges for patients.
You can also use billing software or clearinghouse services to determine accurate cost estimates and determine the financial resources a patient will need weeks ahead of the scheduled service. 2-3 days prior patient visit, your front desk staff must be ready with insurance coverage.
Training to staff:
Your front desk staff must understand the coverage report and should be knowledgeable to explain the coverage report to the patient. Well-informed patients are in a better position to make decisions about planned visits.
Your team member must understand various components of benefits reports like co-payments, co-insurance, unpaid deductibles, procedure code-wise allowable amount, number of allowable visits, and, covered procedure codes.
Be transparent:
Be transparent ahead of time, as early as possible with the patient on what they should expect their bill to be, especially on significant procedures or services. If required provide financial counseling.
Financial clearance is a process that determines a patient’s ability and likelihood to pay, ensures they are notified, and are prepared to financially cover the cost of their services.
Updated guidelines:
Practices should employ new strategies and processes to proactively mitigate unexpected charges and ensure compliance with new federal mandates. You have continuous train your RCM team on payer billing policies and reimbursement guidelines.
Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. As a part of complete medical billing, we share eligibility and benefits reports for every patient visit.
If you are looking for eligibility and benefits services or need assistance in medical billing for your anesthesiology practice, email us at: info@medicalbillersandcoders.com or call us at: 888-357-3226.
FAQs
1. What is surprise medical billing?
Surprise medical billing occurs when a patient receives an unexpected bill from an out-of-network provider, often for services like anesthesia, despite using in-network facilities. This happens when the insurance doesn’t cover the full fee, leaving patients responsible for the difference.
2. How can anesthesia medical billing services help prevent surprise bills?
Anesthesia medical billing services help ensure that anesthesia providers are accurately listed as in-network or out-of-network, reducing the likelihood of surprise bills. These services also help clarify costs and insurance coverage for patients in advance.
3. Why do patients receive surprise bills for anesthesia services?
Patients can receive surprise anesthesia bills when anesthesiologists are out-of-network, even if their surgeon and hospital are in-network. The billing may not align with the patient’s insurance coverage, leading to unexpected costs.
4. How can I avoid surprise medical bills for anesthesia services?
The best way to avoid surprise anesthesia bills is to verify the patient’s insurance coverage and in-network status ahead of scheduled surgeries. Anesthesia medical billing services can assist by providing accurate cost estimates and confirming eligibility in advance.
5. How does MBC help with anesthesia medical billing services?
Medical Billers and Coders (MBC) provide comprehensive anesthesia medical billing services, ensuring proper coding, accurate billing, and clear insurance verification. This minimizes the chances of surprise billing and helps improve reimbursements for your practice.
