Billing for anesthesia services is complicated and it requires skilled staff who can do error-free medical billing. Medical billers should have a basic understanding of how anesthesia is administered, and all the ins and outs of payer requirements to avoid claim rejections. Anesthesia billing needs something of all from the billing team member all the way to the provider. Medical Billers and Coders can help you to succeed at anesthesia billing.
The American Association of Anesthesiologists (ASA) and the Center for Medicare and Medicaid Services (CMS) have regulated certain specific billing and coding guidelines listed below to be followed when you will perform anesthesia billing:
Accurate Base and Time Unit Report
The base unit and numeric values of Anesthesia procedural code calculations are important. A report of time spent on the procedure by the minute is vital for Anesthesia billing.
Start and Stop Time
Documentation of start and stop time of the procedure is compulsory and medical coders are essential to follow specific insurance company’s guidelines and CMS rules to calculate time units.
Multiple Procedure Codes
Some ASA codes contain multiple areas; these codes have a higher base value. Medical coders are essential to use these codes to report procedures on multiple areas and bills with higher base value for maximized reimbursement.
Use of Modifies
Modifiers provide extra information on the procedural coder. Your medical billers should use appropriate modifiers wherever they are reporting CPT codes.
CPT and HCPCS Codes
Correct and complete coding of appropriate procedural coders (CPT), HCPCS, modifiers, and ICD-10 CM provides clear information on the procedure performed. Complete coding shows how and why the procedure was handled, making it easier for getting reimbursed at the first attempt.
Medical Coding Qualifying Circumstances
Qualifying circumstances are medical situations that impact the administration of anesthesia services. Coding and Documenting Qualifying Circumstances increases the reimbursement rate of the claim.
Some payers will reimburse separately and some not for extreme age, hypothermia, or other qualifying circumstances. Indiana Medicaid, as an example, still reimburses for extreme age. So be sure to specify it on the billing sheet and submit it on claims when applicable.
Review and negotiate your payer contracts
Do you remember when it was the last time you pulled out your payer contracts? Do you remember which payers you contract with? Make a plan to review your contracts annually, starting today. And make sure you are getting fair-market value using the ASA’s annual payer survey results.
Charge Master Monitoring
What are your charges per unit for your anesthesia services? And, what about the non-anesthesia services you do? Have you ever evaluated how much you charge to payers? Payers always set their fee schedules based on the average charges they get from providers. Ensure that you are not losing revenue by undercharging for your services.
ICD-10 Documentation and Coding Set
Anesthesiologists have it mainly rough when it comes to the specifically of ICD-10 since they are depending on the surgeon for much of the info about the patient and his condition. Familiarize yourself with what is compulsory, and identify how you can get the info you need to properly code using ICD-10.
About Medical Billers and Coders
We are catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders.
FAQs
1. Why is accurate time documentation important in anesthesia billing?
Accurate documentation of start and stop times is crucial for calculating time units in anesthesia billing. This ensures proper reimbursement based on the duration of the procedure.
2. What role do modifiers play in anesthesia billing?
Modifiers provide additional information about the procedure, helping to clarify specific circumstances. Using the correct modifiers ensures accurate billing and can prevent claim rejections.
3. How do qualifying circumstances impact anesthesia reimbursement?
Qualifying circumstances like extreme age or hypothermia can increase reimbursement rates for anesthesia services. It’s important to document and code these circumstances accurately to maximize reimbursement.
4. How often should anesthesia billing contracts be reviewed?
Payer contracts should be reviewed annually to ensure you are receiving fair market value for your services. Regularly assessing contract terms helps optimize reimbursement rates and avoid revenue loss.
5. How can Medical Billers and Coders (MBC) help with anesthesia billing?
MBC offers specialized billing services for anesthesia, ensuring compliance with coding guidelines and payer requirements. We help reduce claim rejections and maximize reimbursements for your practice.
