The nature of anesthesia billing is comparatively more complex than that of other physician billing services. This is because they run on a pay-for-service schedule which consists of an elaborate system including base units, modifiers, and time units.
This means that there are more chances of errors and possible claim denials. This post discusses the most pressing challenges anesthesia medical billers face today.
Administration of general anesthesia results in a medically induced coma where the patient loses their protective reflexes for a certain time period. If a situation arises where a patient’s case is canceled before the anesthesiologist commences induction, the reason for this has to be properly recorded.
The report also needs to include the situation-specific evaluation and management code.
To be able to assign the correct modifiers, it’s important for anesthesia medical billers to accurately record such case cancellations in a timely manner.
- Monitored Anesthesia Care (MAC)
Billers are also required to carefully record cases of MAC. In the case where a patient loses consciousness, the time spent is considered general anesthesia, not MAC. This can get confusing as most insurance carriers have their own standards and specifications when it comes to monitoring and observing MAC.
- Post-Anesthesia Care Unit (PACU)
The average time spent in PACU is 7 minutes. If the aggregate of all cases falls above the seven-minute mark, it could send a red flag to medical auditors for potential fraud. Clear records and detailed supporting documents will allow auditors to check for anomalies, if any.
Accurate Report Times
Anesthesiologists get paid based on time units and so, it’s crucial that they record and report time as accurately as possible. Unfortunately, reporting time is a fairly complex process. It involves more than denoting beginning and ending times of patient care.
Several aspects are involved in detailed time reporting. If these are not addressed properly, they can lead to loss in revenue and even audits and penalties.
- Documenting Relief Time
Relief time is the period between one anesthesiologist taking a case over from another. In such situations, there have to be two start-stop timelines recorded on the time reports. To prevent incorrect reporting, relief time should be documented accurately.
- Reporting Discontinuous Time
This refers to the intermittent time between anesthesia care for a patient. Billers have to base their work on the specific discontinuous time in between treatment. The record needs to show the precise start and stop times as well as the total time given to anesthesia care.
Such reporting allows medical billers to know the time periods before and after care was halted. It also lets them check the discontinuous time box.
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To learn more about their services, visit their website here.