Anesthesiology practices have a host of special billing requirements! These range from intricate coding needs to stringent regulatory compliance. Outsourcing medical billing services is an easy way to reduce these burdens. You just need to partner with billing experts who understand the subtleties of anesthesia revenue cycle management.
Here is a step-by-step checklist on how to choose and leverage the correct RCM vendor to improve reimbursements, compliance, and efficiency.
1. Partner with a Vendor That Has Anesthesiology Expertise
There are high-level coding rules with anesthesia billing, including time-based billing, modifiers, and several CPT codes (01996 for obstetric anesthesia). Beginning generic RCM vendors might lack the ability to handle these and therefore result in undercoding, denial, or even non–compliance.
Action Steps:
- Make sure that the vendor has knowledge of anesthesia–specific coding such as base units, time units, and physical status modifiers.
- Check whether the billers specialize in handling payer policies that cover anesthesia services. Examples are bundled payments or Medicare’s Medical Direction policies.
- Ask for references or case studies from similar-sized practices.
2. Give Top Priority to Compliance and Data Security
Anesthesia practices deal with sensitive patient data and are audited (e.g., OIG, MACRA) and regulated (e.g., HIPAA). Their medical billing service partners need to be compliant with these rules when dealing with anesthesia compliance risks like documentation of the medical necessity of pain management procedures.
Steps to Take:
- Make sure the vendor is HIPAA-compliant and a frequent subject of security audits.
- Make sure their company has certified coders (CPC, CANPC) and compliance specialists (CPCO) onboard.
- Describe how they stay current on rule changes, i.e., CMS updates or state regulations.
3. Opt for Seamless Integration of Technology
PM/EHR systems like Cerner or Epic are common in anesthesiology practices. Just ensure to seamlessly integrate the software of the medical billing service vendor. This can help prevent delays and data entry mistakes. Besides, check eligibility criteria in real time and file claims electronically to manage emergent cases and reduce denials.
Steps to Take:
- Maintain compatibility with existing systems via HL7 interfaces or API links.
- Evaluate translation of AI-driven applications for coding accuracy and denial prevention.
- Select cloud-based platforms that include real-time analytics and mobile capabilities.
4. Demand Transparency and Tailored Reporting
Data specific to anesthesiology, such as average days in A/R, percentage of denials on time unit claims, and collection rates for different payers are vital to measure performance. Bland reports are not helpful.
Steps to Take:
- Order sample reports on medical billing services to show anesthesia KPIs.
- Seek access to a dashboard that tracks payer trends, claim status, and root causes of denial.
- Schedule reviews regularly to update strategies using data insights.
5. Analyze the Infrastructure for Support and Communication
Ensure effective communication to respond to time-sensitive issues. These may include coding disputes or prior authorization delays. To avoid them, you need to work with an account manager expertized in handling these issues for anesthesiology practices.
Steps to Take:
- Ask about support hours (e.g., 24/7 for urgent billing questions).
- Judge their patient support features, i.e., bilingual representatives for ethnically diverse patient bases.
- Ask about escalation procedures for denied or high-priority claims.
6. Compare Cost vs. Value
Cost is a consideration when outsourcing medical billing services but the lowest price may mean sacrificing expertise or technology. Percentage-based models provide vendor incentives with your collections, whereas flat fees offer predictable costs.
Steps to Take:
- Compare surcharges and fee structures such as setup and software licensing.
- Gauge potential ROI depending on how they trace their average increase in collection rates.
- Negotiate denial resolution timelines and first-pass claim success rates within SLAs.
7. Check Referrals and Endorsements to Verify Reputation
Reputed vendors will gladly show you referrals from anesthesia groups. Ask for demonstrated success in improving payments, reducing denials, and managing audits.
Steps to Take:
- Look for third-party reviews from sources like Google or Clutch.
- Inquire about their experience in handling payer mix issues (such as, government vs. commercial payers).
- Check their contingency plans for system crashes or staff shortages.
Take Your Anesthesiology Practice a Notch Higher with Strategic Outsourcing
Outsourcing anesthesiology medical billing services allows practices to maximize revenue and focus on patient care. Choose a vendor who offers specialization in anesthesia billing, open processes, and solid technology. This helps practices maintain compliance, reduce denials, and improve cash flow. Partner with an RCM provider that acts as an extension of your team, offering customized solutions for the unique needs of anesthesia billing.
Final Advice:
- Assess the vendor’s performance by starting with a pilot phase before making long-term commitments.
- Audit billing processes regularly to identify areas for improvement.
- Stay in touch with your vendor to adapt to changing requirements of your practice and payer policies.
Follow these effective practices to help your anesthesia practice achieve operational efficiency and sustainable financial stability.
