Anesthesia practices face complex challenges in revenue growth that stem from Medicaid billing, including changing eligibility rules, inconsistent payment rates and state-specific Medicaid plans that do not provide a standardized approach to billing.
Coronis Health addressed these challenges and solutions in a Dec. 3 blog post that breaks down specific billing rules for different anesthesia services and how providers can optimize their approach for improved financial health.
Four key takeaways are outlined below.
- Unlike Medicare, which has standardized guidelines nationwide, Medicaid plans vary significantly from state to state. Payment rates are set by state budgets, leading to a wide range in payment rates across the country. This creates a complex and often unpredictable billing environment for anesthesia practices that leads to added administrative burdens and concerns over financial viability.
- Many states have implemented managed care systems to reduce Medicaid costs — take for example Arizona's Health Care Cost Containment System. These plans often come with unique eligibility and payment rules, complicating the claims process, particularly in geographic areas with multiple plans. This lack of consistency makes it challenging to establish uniform billing practices, optimize reimbursement and stay compliant.
- Medicaid payments rely heavily on eligibility verification, which is tied to specific financial criteria and may be restricted to certain periods. It's crucial for practices to thoroughly understand and navigate eligibility rules to ensure proper billing and payment. Different states also have specific rules for various types of anesthesia services. Obstetric anesthesia and medically directed cases may involve different billing rates and rules. Making sure staff are aware of rules like anesthesia reporting time and how flat-fee services are paid is crucial for success.
- Despite the low net yield from Medicaid claims, they remain an important revenue source. Many providers lump Medicaid with self-pay due to similarly low returns. However, understanding the intricacies of Medicaid billing is essential, as any revenue collected contributes to the overall financial viability of anesthesia practices.