Medical practices face complex challenges in order to maintain a healthy bottom line. Billing for anesthesia services can be even more complicated. These particular challenges can be overcome by monitoring and streamlining the advanced processes involved in maximizing revenue. Here are 5 tips for improving anesthesia billing practices.
1. Monitor Contracts And Be Familiar With Payors: Anesthesia billing can be more complicated for billers and payors. If a contact is particularly difficult to manage claims can be processed incorrectly, therefore it is crucial to closely monitor contracts and follow up with payors to be certain they are processing claims correctly. Billers need to be familiar with each contract and its cycle, and know what they should receive for the claims.
2. Collect From Patients Up Front: The collection process is an area where many anesthesia providers need improvement. In the last few years, collecting payment from patients has changed dramatically. Billers used to charge the payor and send an invoice. Receiving payment was less of a worry because patients had better means to pay and their deductibles weren’t as high. Billers today have to be much more aggressive to receive payment. Some practices are now requiring payment before services are performed.
It is important to educate patients about the costs of the services they will receive so that they are well informed about what payments they will be responsible for. Discuss a payment plan with the patients who cannot pay in full up front so you both can expect the bill to be paid off quickly.
3. Maintain Effective Collections: An anesthesia biller’s number one priority is to completely capture everything for the day. Ask yourself how long it takes for charges to be entered after service, and how long it takes the practice to submit the claims to the clearinghouse. Charges should be entered within 24 hours of service and claims to the clearinghouse should be made nightly.
Billers should always be sure that the correct payor is being billed, that any and all modifiers are added and that the payment policies of the payor are being adhered to in order to get a claim paid.
Also, be vigilant in monitoring how long unpaid services remain in A/R. Most of your accounts should be in the 30 day range. If you have unpaid services in the 60 or 90 day range you have room for improvement.
4. Be Aware Of Compliance: Providers are accountable for compliance with the Health Insurance Portability and Accountability Act. There are countless opportunities for HIPPA violations everyday, so medical practices, anesthesiologists and billers need to keep aware of the rules and have a plan for staying up to date on changes. Changing laws have dramatically increased the ability of the U.S. Department of Health and Human Services (HHS) to impose monetary penalties for these violations. HHS is expected to take more formal action when there is willful neglect involved in a violation. Four recent changes that will have a significant impact on providers are:
- Business associates and their subcontractors are now liable for breaches of personal health information (PHI).
- Rights of patients to obtain electronic copies of their records have been enhanced
- Rights of individuals to request restrictions regarding disclosure of their PHI have been enhanced
- Any disclosure of PHI is now presumed to be a breach under the breach notification rule
Technology can be your best friend when it comes to compliance. Our coding system includes regulatory compliance checks.
5. Pay Special Attention To Post-Op Pain Blocks: Failure to properly document and bill for post-op pain blocks (POP) can result in a reimbursement issue and a compliance issue as well. Practices need to take the time to ensure that their entire billing staff is aware of what is needed for post-op blocks.
A surgeon and anesthesiologist will frequently use the same document to record the anesthesia event and the POP. This usually results in a denial of the claim by the insurance company the first time around. A second form is good practice to clearly separate the POP from the anesthesia delivery used for the surgery itself. It is vital to document the surgeon’s request for the block and a second reason for why the POP was administered. If the request is not included in the patient’s record, it can be appealed, which will prevent timely payment.
Because billing for anesthesia and POPs is so complex, billers should not assume that all of the documents are complete. Doing so can be just as bad as up-coding. Put a specific plan in place for how your staff will handle the documentation of these procedures.