Billing for anesthesia services requires specific training and knowledge to correctly maximize a provider's revenue.
Jody Hinton is the director of billing operations for the central division at abeo in Fort Worth, Texas, a billing and practice management company that works largely with anesthesia practices. Ms. Hinton works with anesthesia billers to make sure their revenue cycles function optimally and efficiently.
Here are Ms. Hinton's five tips for improving anesthesia billing practices.
1. Stay informed with payors and contracts. Anesthesia cases can be more complex for billers and payors, so Ms. Hinton recommends keeping an eye on contracts and repeatedly following up with payors to make sure they are processing claims correctly.
Up to 40 percent of claims can be processed incorrectly the first time if a practice has contracts that are difficult to manage. Billers should be familiar with the contracts and know what they should be receiving for the claims.
"We hold payors accountable for the contracts they sign and get them to appropriately pay contracts," she says.
It's also important to revisit contracts frequently and know a contract's cycle. Gone are the days where you sign a contract and leave it for three years, she says.
"Renegotiate a contract six months prior to its expiration," Ms. Hinton says. "Don't get caught in the evergreen cycle where they auto renew and you are stuck for another 12 months."
When approaching contract negotiations, know the types of cases you perform and where you get the "biggest bang for the buck," she says. Since anesthesia is billed per unit, it could either be more profitable for a practice to carve out lines or blocks performed frequently or to give up carving for a great rate per unit. Each practice is different.
Look at industry benchmarks for your market and decide what rates are comparable and competitive, she says.
2. Be aware of compliance. You are accountable for Health Insurance Portability and Accountability Act guidelines, whether you know them or not, Ms. Hinton says. "Day-to-day there are hundreds of opportunities for HIPAA violations," she says. Anesthesia practices and billers should work to stay educated about the rules and follow through.
It's important to develop a policy to make sure violations are avoided.
"You should have a compliance policy that is robust enough to meet federal and state requirements, but not so restrictive you can't function within in," she says. "It's a fine line."
Technology can be your best friend when it comes to compliance. Proper software coding systems will include regulatory compliance checks. Be educated and have a plan.
3. Collect up front from patients. Collecting from patients is the area where most anesthesia providers need to improve, Ms. Hinton says.
The process for collecting from patients has drastically changed for anesthesia in the last few years. In the past, anesthesia billers would charge the payor and then send an invoice to the patient. If the patient didn't respond, it wasn't a major problem. Patients were more able to pay, she says, because they had fewer out-of-pocket expenses, their deductibles weren't as high and their incomes were better. Now, companies have to more aggressively go after patient payments.
Some practices have pre-payments where patients have to pay their bills before services are rendered. She recommends educating patients about the services they will receive and the cost of those services so the patients are informed as to what they will be responsible for paying. Work out an aggressive payment plan with patients who cannot pay in full up front so they can pay the bill off quickly.
4. Process claims quickly and correctly. The top priority for anesthesia billers is to completely capture everything for the day, Ms. Hinton says. With the evolution of electronic medical records, often a nurse will fill out the procedure field, and occasionally the booked procedure was not the procedure performed. Develop a system to make sure correct documentation happens for every claim.
Billers should be vigilant to check that the correct payor is being billed, that the appropriate modifiers have been added and that the payment policies of the payor are being followed to get a claim paid. When the claim is correct, payors will have to appropriately reimburse you.
"Just because they denied it, doesn't mean they will not pay," she says. "Don't take no for an answer."
Ms. Hinton recommends processing claims in four days or less. Processing includes everything from prepping the claim and checking eligibility to reviewing it for quality and sending it out the door.
"The sooner you can process a claim, the better," she says, "but we are not going to sacrifice on the quality side to get it out faster."
5. Stay educated with industry changes. Billing for anesthesia is much different than billing for a family practice or surgery, so staying educated is crucial for a practice.
"Things are always changing and every state is different," Ms. Hinton says. Billers need to know how their state processes claims, including Medicare and Medicaid, and how anesthesia charges work.
For someone brand new to anesthesia billing, she suggests attending an anesthesia billing conference to meet other billers and learn the nuances.
Stay up with industry trends, she says. Staff members may need to be trained internally to make sure they understand your practice's specifics and what's required for documentation.
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