Billing for Anesthesia Services; How to Reduce Claim Denials

Minimizing claim denials is the goal of every medical biller because denied claims represent delayed or lost revenue. With proper processes and workflows in place, your medical billers can quickly and effectively avoid or resolve denials that directly impact your billing costs and revenue. 

Below are the best practices to proactively reduce claim denials.

Understand the Fundamentals of Anesthesia Medical Billing

What makes billing for anesthesia services more complex than other specialties is its unique payment system that includes:

• Base units – each anesthesia procedure code has a corresponding base unit value assigned by CMS. The more complex the procedure, the higher the base unit. 
• Time units – these represent the period during which an anesthesia practitioner is present with a patient. It is computed by dividing the reported anesthesia time by 15 minutes.
• Modifying units – these account for special conditions or emergencies that may affect the anesthesia service.
• Conversion factor – this number is determined for each locality where services are performed. 

The formula for reimbursement for anesthesiologists or CRNAs:

(Base Factor + Total Time Units) x Anesthesia Conversion Factor x Modifier Adjustment 

For anesthesia performed under medical direction:

[(Base Factor + Total Time Units) x Anesthesia Conversion Factor] x Modifier Adjustment 

These fundamentals show how anesthesia billing is not your run-of-the-mill medical billing. By having a basic understanding of how anesthesia care is provided and knowing the best practices in anesthesia medical billing, you can avoid denied claims.

Adhere to Anesthesia Coding Guidelines

Different types of anesthesia have unique billing codes, which can be confusing for billers who lack an understanding of anesthesia services. Knowledge, coupled with clear and accurate documentation of codes and modifiers, can help avoid confusion.

Modifiers are required to be added to procedure codes when billing. They are two-character indicators that signify relevant details, like age, physical status, and emergency factors on a claim. When billers are unaware of proper modifier usage, the result can be inappropriate billing and denied claims. The correct modifiers and codes are essential to ensuring consistency and accuracy in reimbursements while remaining compliant. They also avoid unbundling and duplicate billing. 

The Healthcare Common Procedure Coding System (HCPCS) indicates modifiers specific to anesthesia services and are a standard on claims submitted to Medicare and many other payers. 

What to Do When Claims Are Denied

When claims are denied, the biller performs a root-cause analysis to identify issues that need correction. Once the reason for the denial has been identified, the biller proceeds with the following actions:

• Gather the required appeal documentation – this typically includes a letter of appeal that explains why you are appealing and how your documentations support those reasons. Supporting documentation may include patient lab reports and progress notes. You also need a claim number or an Explanation of Benefits (EOB) to avoid duplication and track your claim.
• Follow the insurer’s specific appeals process – each insurance company has a unique way of accepting appeals. Billers must ensure they are aware of the requirements.
• Send the appeal to the payer – billers know where to send claims, typically from the mail or the company’s website after receiving the insurance-specific forms. The address may also be seen on the EOB.

Follow Up on Denied Claims

Following up on denied claims helps you run your facility smoothly and successfully, as you ensure every owed amount is received as quickly as possible. 

When following up, ask the following questions and record the responses:

• When was the claim received? – follow up with the insurer within 30 days to verify if the claim was received and is in process.
• Has the claim been assigned a number? – make a note of the number provided.
• Are additional documents needed to complete the claim processing? – follow up in 7 to 10 days to make sure the claim is in process. 
• What is the target completion date for the claim processing? – make a note of the date and expect payment.
• What is the reference number? – keep track of this information, as it lets you document all calls and names of contacts going forward.

Consider Outsourcing Your Anesthesia Billing Services 

Is your facility looking for ways to get paid for pending claims or denied claims? This is where a dedicated A/R follow-up team can benefit you.

An outsourced anesthesia medical billing team not only tracks and manages each claim but also provides complete, real-time visibility of your cash flow. Your billing partner’s A/R follow-up and denial management team are in charge of investigating rejected claims and reviewing them to collect maximum compensation. They will have the knowledge, experience, and the right set of tools to ensure you receive the last dollar you are owed.

At Coronis Health, we utilize denial management software designed to monitor claim status, allowing us to increase the first-pass rate significantly. By staying abreast of medical billing trends, future denials are avoided before they can happen, allowing your facility to collect timely payments for services provided. We analyze denied claims to help you create better workflows with services such as coding deficiencies, appeals, authorizations, and more.

Our thorough and meticulous approach to collection gets results. With our decades of experience providing tailored solutions, we can ensure your collections are efficient and denials are kept to a minimum. To learn more about how you can benefit from our anesthesia medical billing services, contact Coronis Health to request a free financial check-up. 

from
https://www.coronishealth.com/blog/billing-for-anesthesia-services-how-to-reduce-claim-denials/