PERFORMANCE THAT MATTERS

AdvantEdge Healthcare Solutions ahsrcm.com info@ahsrcm.com 30 Technology Drive, Warren NJ 07059 877 501 1611

3 Tips for BetterAnesthesia Billing

PERFORMANCE THAT MATTERS

AdvantEdge Healthcare Solutions ahsrcm.com info@ahsrcm.com 30 Technology Drive, Warren NJ 07059 877 501 1611

3 Tips for Better Anesthesia Billing

3 TIPS FOR BETTER ANESTHESIA BILLING

Billing for anesthesia services faces many challenges that often lead to sub-optimum results and lower revenue. Here are three areas to inspect to make sure your cash flow is on target and to avoid compliance risks: 1. Coding accuracy 2. Billing workflow 3. Information (reporting)

CODING ACCURACY

The coding process provides the key inputs that drive reimbursement: i.e. the specific procedures that were done, supported by diagnosis specifics. Not only must they be described accurately (correct ICD and CPT codes) but the appropriate modifiers and units need to be applied (which can vary by payer).

Here are some key questions to ask: - Are all of the coders certified? - What information sources do coders have for the most recent code updates? - How is concurrency handled? Does it require manual calculations or is it automated? - What is the process for questions and clarifications (on case documentation)? - How often are documentation recommendations provided to your providers from the coders? - Are coders certified in ICD-10? - Are PQRS and other quality metrics being tracked? - What is the rate of medical necessity and other coding related denials?

BILLING WORKFLOW

On the surface, the billing process can look straightforward. But when inspected closely, there are many steps that need to be performed flawlessly. Fortunately the majority of claims are typically paid correctly. But the difference between optimized cash flow and losses of 5 to 10 percent or more is in how exception cases are handled: e.g. missing records, denials, under payments, etc.

PERFORMANCE THAT MATTERS

AdvantEdge Healthcare Solutions ahsrcm.com info@ahsrcm.com 30 Technology Drive, Warren NJ 07059 877 501 1611

3 Tips for Better Anesthesia Billing

Some important questions to ask about your billing workflow: - Is demographic information received electronically? If so, how are transmissions tracked

to identify missing records? - How is demographic information verified when there are discrepancies? - Are cases received checked against OR schedules to identify missing cases? - How extensive is the claim scrubbing process? What is the first pass clean claims rate? - How are denials processed? Are they automatically assigned? Are they tracked? How long

can they sit without escalation? - Are “black hole” claims identified? (claims filed with no action by the payer) - Is there a process to identify under payments? How does it work? - How are payments received (e.g. lockbox, EFT) and are EOB’s reconciled?

INFORMATION

There are many reports expected from anesthesia billing. The most common include: “charges, payments and adjustments;” accounts receivable aging and volume. But the most value comes from being able to inspect and analyze the information in a convenient manner: e.g. by payer, by location, by physician, etc. In addition, there is a wealth of non-financial information available from the billing process and extensions to it. Examples include productivity from RVU data and analysis of OR utilization by including an OR identifier on the anesthesia record. Other examples are quality measures, whether AQI or hospital-specific.

In today’s healthcare environment, anesthesia groups and hospitals needs much more than a few reports. Do you have the ability to: - See current information in an online “dashboard”? With drill down? - Easily share information on a HIPAA-secure basis? - Get customized reports on a regular basis (e.g. daily, weekly, monthly)? - Generate Excel exports of the data you want, whenever you choose? - Drill down into dashboards and reports? - Add data to the billing process for quality and other purposes? - Report on this added data? - Quickly and easily provide the data needed by your hospital administration?

SUMMARY

Anesthesia billing has many nuances and “moving parts.” But inspecting the 3 dimensions described here will let you quickly identify areas that can be improved. Like any operating process, anesthesia billing—whether done by an internal staff or an outside partner—should incorporate ongoing improvement. The questions listed above suggest best practices that need to be utilized to achieve top notch results.