Anesthesia Billing & Management

Last month, The American Society of Anesthesiologists (ASA) launched a nationwide campaign opposing the Centers for Medicare and Medicaid Services’ (CMS) proposal to pay nurse anesthetists for chronic pain service. The crux of the opposition is that nurse anesthetists are not equipped with the necessary formal education or training in chronic pain management.

“Even in the hands of specially trained physicians, chronic pain procedures are inherently dangerous due to the anatomy and delicate structure of the spine and nerves upon which chronic pain interventions are performed,” said ASA President Jerry A. Cohen, M.D. “Current restrictions on nurse anesthetists providing these services are appropriate and necessary in the interest of patient safety.”

In addition to the health risks, the ASA says there is also the risk of extensive and costly medical interventions. They argue the point that anesthesiologists and other doctors are better equipped to provide pain management care and minimize these risks due to their education and training, and are able to prescribe appropriate medication therapies in the process. 

Chronic pain services will often include opioids, where specialized physician training is required to minimize errors and prevent potentially lethal side effects.

“Using scarce Medicare dollars to pay nurse anesthetists to perform complicated pain service procedures unnecessarily puts patients at risk,” says Cohen. “Patients who require anesthesia or relief from pain deserve the safest and highest quality of care.”

There is a transition underway to the 5010 HIPAA electronic claims standards. The American Society of Anesthesiologists has announces that, as part of this transition, there will be a universal system for reporting anesthesia time to all payers which will go into effect January 1, 2012. This new standard will require all anesthesia time to be reported in minutes instead of units. While some payers already use this system currently, by January, 2012 it will be a requirement for all payers.

The ASA has spent years successfully lobbying against this change, but change is on the way. Part of the resistance was due to the fact that the change can cause some payers to move from a full unit to fractional unit payment system. While this may benefit some anesthesia providers it may also cost some providers money, depending on when individual contracts permit rounding to the next unit. According to the report, the change will not stop contracts from rounding to the nearest whole unit when determining payments.

Changes to commercial payment contracts will have to be negotiated between anesthesiologists and commercial providers. Anesthesiologists should be aware of this change when negotiating contracts with payers.

There are many reasons for Anesthesiologists, or any other medical practice, to hire a medical billing company. If you are considering a medical billing service for your practice, there are several types (or sizes) of companies to choose from. There are large national firms and small local medical billing companies that may be able to give you a little more of a personalized service. There are even offshore companies that perform medical billing services.

But, the most important thing to know about potentially hiring a medical billing service is, how does it benefit your medical practice? There are many, but possibly the most important is that it will increase your bottom line.

One of the misconceptions of hiring a medical billing company is that it will become an expense. In reality, a quality medical billing service will not only pay for itself, it will increase your profits. If you are performing your billing in-house, when you add the expenses related to hiring a billing staff, hardware and software, and IT support, the costs will often exceed the medical billing company’s fees.

Anesthesiologists in particular can benefit by outsourcing anesthesia billing, as most anesthesiologists spend the majority of their time in a hospital setting separated from the billing and operations side of their business. Hiring a medical billing company that understands the billing & coding processes for anesthesia can greatly increase profit and patient care.

If you outsource your medical billing processes to a company that knows its business intimately, they will find ways to eliminate hidden costs. Your medical practice splits its time and resources between patient care and the billing process, whereas a medical billing company concentrates their entire effort on handling your billing. They can do it more efficiently, which brings costs down and profits up.