Compared to other healthcare areas, anesthesia is a challenging segment to bill and code. The medical billing transmission services must be based on a thorough understanding of payer requirements, laws, and specifications and the intricate process differences of this particular segment.
Because of the challenges involved, most anesthesia experts outsource medical billing transmission services to expert third-party service providers and do not get it done in-house. When it comes to anesthesia billing, three factors determine the final charges captured – time, difficulty of procedure, and addition of modifying factors (depending on the modifications made to the generic service).
Let’s look at how medical billing transmission service providers handle the first factor – time.
There are three basic time definitions that add to the total charges made by the billing team.
Start time is the time when the anesthesiologist and/or the certified registered nurse anesthetist (CRNA) start preparing for the procedure physically. Do note that this time would not typically involve the pre-anesthesia evaluation. The charges start from starting the IV to administering pre-anesthesia sedation and preparing the patient for the process.
Discontinuation time is the time between the start time and the end time, where the anesthesiologist is not typically involved in the procedure or is required to be in attendance. The medical billing transmission service providers must take care not to bill this period. If the charges are also captured for this period, this would end in denied claims.
End time is the actual time of surgery/procedure where the anesthesiologist or the CRNA has to be present and attend the process. This time continues until the patient is kept safely under post-anesthesia care. Some of the medical billing transmission service providers miss out on some of the portions of the end time.
This means that when they could have charged the payer for 45 minutes, they did so only for the first 30 minutes and missed out on the period where the practitioner stayed back to monitor vital signs until the patient was put under post-anesthesia care. Just like how overcharging is detrimental, undercharging is equally regressive as it brings down the potential revenues the client can bill.
Generic considerations for anesthesia medical billing transmission services
The first thing to remember when medical billing transmission services bill for a particular anesthesia service is to not round off the time and specify the exact time recorded. This is one of the common reasons that lead to denials.
If an anesthesia stand-by is required, then it is important to check with the payers if they allow for stand-by payments. Some payers only pay for the primary service provider and don’t allocate reimbursements for stand-by physicians.
Some of the patients may require post-operative pain management and again, the allowance depends on the type of coverage and the payer chosen. It is the task of the billing team to check this in advance and inform the patient of the same.
If a physician requires local anesthesia, unless it is administered by a professional anesthesiologist, the process is not billable.
Anesthesia time definitions – FAQs
1. What happens when two anesthesia physicians handle a particular case?
If two or more physicians handle a particular surgery or procedure, then a segment called relief time needs to be introduced. Medical billing transmission service providers also refer to this as split time.
In this process, two start and stop timelines have to be determined based on when the first physician started and finished and when the second physician took over. The bill is often made under the name of the physician who handled the case first.
2.Are pre-evaluation and post-evaluation processes billable in anesthesia procedures?
No. Pre-evaluation and post-evaluation processes aren’t billable and should be excluded while calculating the time.
3.What happens when a procedure is canceled after the involvement of the anesthesia expert?
There are two scenarios that medical billing transmission service experts must be aware of in terms of canceled procedures.
The procedure is canceled before the patient is induced – In this case, the billing experts can capture charges for evaluation and management alone if the same patient doesn’t have the procedure rescheduled within the next 48 hours. If that is the case, this evaluation and management process will be bundled with the proceeding process charges.
The procedure is canceled after the patient is induced – In this case, the medical billing transmission service provider can capture the charges for all processes rendered by the anesthesia service provider up until the time of cancelation of the procedure. In this case, the billing provider must remember to use the 53 modifier to state why the charges are captured halfway through.
4.What is the main thing to remember while billing relief time?
The main thing to remember to prevent denials while billing relief time is to ensure the first physician’s stop time and the second physician’s start time is at least one minute apart.
5.What is Monitored Anesthesia Care (MAC)?
MAC is a service where the anesthesia provider continuously monitors the patient’s vitals and is ready to diagnose or treat complications that arise while the patient is sedated. Two of the common modifiers that medical billing transmission service providers use for MAC are:
G8 – MAC for complicated or invasive surgeries and procedures
G9 – MAC for patients with known cardio-pulmonary conditions
With Quintessence’s experience handling medical billing transmission services for various clients, anesthesiology remains one of the departments requiring expert-level precision and unwavering focus.
Thankfully, our team comes with hundreds of years of combined working knowledge, and we ensure all our anesthesiology clients benefit from optimal billing and transmission services. Our SLAs include a reduction in denials rate, overall process improvement, and increased cash flow and revenue from the beginning of our partnership.
If you are an anesthesiology service provider wanting to optimize your RCM operations, Quintessence Business Solutions and Services can be your able and worthy partner. Do contact us to know more.
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