Anesthesiology: Time Based Billing Complexity and Solutions

Complexity in Anesthesia Billing  

While billing teams across all medical specialties are faced with revenue cycle challenges, it often feels like teams in the anesthesia field are faced with additional layers of complexity. Intricate requirements in documentation, reimbursement structures, and time-based billing make maximizing reimbursement for anesthesia services an uphill battle. 

In this blog, we’ll dive into the unique challenges facing revenue cycle teams in anesthesia and how AI driven revenue cycle technology is helping teams overcome these challenges.

Pre, Post, and Intraoperative Anesthesia 

For revenue cycle teams in anesthesia, accelerating revenue growth and driving RCM efficiency as the company scales is no easy task. 

The intricacies required in documentation for pre-anesthesia, intraoperative anesthesia, and post anesthesia billing and coding increase room for error — making it challenging to minimize denials and underpayments while maximizing reimbursements. Any small mistake in coding for any part of the anesthesia journey will result in a costly denial, so it’s incredibly important that teams are working to proactively prevent denials before they even occur.

Coding Complexity

In anesthesia, on top of determining the CPT code of the procedure performed, billing teams must differentiate between medical direction vs. medical supervision as well as record base units, time units, modifying units, and conversion factors. 

1. Base units - identify the complexity of the procedure
2. Time units - identify the time spent providing care (1 unit = 15 minutes of anesthesia time)
3. Modifying units - indicate patient health conditions and/or emergencies
4. Conversion factor - the cost assigned to each unit, specific to provider’s location

These factors are used to calculate the charge of the anesthesia. This calculation often looks like:

(Base + Time + Modifying) x Conversion Factor = Charge

Any error in unit reporting or calculation will result in denials, or worse, compliance issues and fraud allegations. For example, per Medicare, the average time an anesthesiologist spends with a patient in the Post-Anesthesia Care Unit (PACU) is 7 minutes. If your team is being audited and it appears that the majority of your PACU time is greater than 7 minutes, you may be flagged as fraudulent unless you have proper, detailed documentation.

As a result, anesthesia practices are looking to AI-driven revenue cycle technology that can constantly monitor for anomalies like this, ensure claims are being submitted accurately, and detect denial trends so they can be addressed immediately. This type of technology is helping teams predict and prevent denials, stay on top of changing payer rules and requirements, and ultimately collect more revenue.

Adonis Intelligence: Helping Anesthesia Billing Teams Prevent Denials

Adonis Intelligence uses AI to provide insights and solutions that can help you optimize your revenue cycle. With Intelligence, you can maximize reimbursements, reduce revenue loss, speed up payments, and lower the costs associated with collecting payments.

Key features and benefits:

• AI-driven insights: Adonis analyzes your revenue data using AI. It identifies patterns and provides actionable insights to improve your financial performance.
• Reduce revenue leakage: The platform helps you spot and fix issues that cause revenue loss. This means more money stays in your practice.
• Improve accounts receivable: Adonis streamlines the process of collecting payments. It helps you get paid faster, improving your cash flow.
• Lower cost to collect: The platform makes the payment collection process more efficient, reducing the time and money spent on chasing payments.

These benefits enable your team to:

• Simplify billing by making the process more transparent and accurate.
• Help you lower the rate of claim denials by using our AI-powered tools to identify common mistakes, like coding errors, and provide solutions before claims are submitted. 
• Accelerate the payment process. We streamline accounts receivable and help you get paid faster. 
• Keep you up-to-date with regulatory changes and make sure your documentation meets all compliance standards. 

Learn more about how Anesthesia practices are benefitting from Adonis Intelligence, here.