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Anesthesia billing has always been a daunting task due to the never-ending changes in the federal rules and regulations. There are many factors that would affect the reimbursement. It is imperative anesthesia billers understand the intricacies associated with the billing else there would be high risk of incurring heavy penalties and fraudulent charges.
An in-depth knowledge in CPT, ICD-10 and HCPCS is essential along with the anesthesia basic guidelines of assigning proper time units, modifiers and evaluate the record for medical direction and supervision which might affect billing.
Prompt reimbursement is often dependent on how well the coder and billers stay up to date with anesthesia payer guidelines, modifier changes, updated procedure and diagnosis codes, MACRA, MPFS, etc. Billers need to comply with the office inspector general (OIG) work plan preventing fraud and non-compliance.
Anaesthesiologist invest most of their time in the hospital which also means they have very limited access to the business operations. Rely on us healthcare services provide effective anaesthesia solutions minimizing your attention to RCM and maximizing your focus more on the patient care.
Time calculation: It is very evident that time units plays a key role in determining the payment in anesthesia billing. Many a times, coders confuse anesthesia start and stop time with procedures start and stop time or might calculate minutes incorrectly ending up reporting incorrect time.
Knowledge of payer guidelines is vital for the correct calculation of time units. Anesthesia is a unique specialty wherein the biller would also need to know about concurrent procedures and the time associated with it.
Modifier usage: Another key factor in coding anesthesia reports is modifiers. Every anesthesia procedure code is followed by physical status modifiers which is again payer-specific. For Medicare, Medicaid and HMOs, usage of physical modifiers is only for statistical purpose while for commercial payers, the same affect the reimbursement.
Anesthesia services for screening colonoscopy: Medicare waives the patient’s deductibles and coinsurance for anaesthesia provided during screening colonoscopy however for diagnostic colonoscopy, coinsurance is exempted. In order to report anaesthesia services for a screening converted to diagnostic colonoscopy, it is imperative that the biller is aware of the payer rules in each circumstance.
Year after year, common documentation and coding errors always put the anesthesia practice to leave significant dollars on the table. Availability of essential resources like reference to the ASA’s RVG guide, knowledge of payer guidelines for time calculation and a good practice management system can strengthen the process of reimbursement and limit potential denials.
Eye for detailing: With the complexities anesthesia billing is facing, utmost precision and clarity is expected. Rely on us is capacitated with a team synergized with knowledge and experience which can help your practice increase the reimbursement complying with payer and federal regulations.
Process mapping: With years of experience, best practices and proven examples, Rely on us can help you fix the gaps in the technology and process by our unique way of addressing.
Transition management: Rely on us is adept in seamless transition and ensure to map the best practices with exclusive attention to our clients.
The anaesthesiologist should ensure to document the arthroscopy procedure if it is diagnostic or surgical, since it affects base unit determination. Although knee arthroscopies are common, shoulder arthroscopies remain a common area for under documentation.
Anaesthesiologist are entitled for 8 base units if radical hysterectomy with removal of lymph nodes and biopsies are performed however documentation restricts the billers to claim for only 6 base units for total abdominal hysterectomies. Due to the lack of detail and clarity in the procedure performed, providers are prone to revenue loss.