Revenue cycle management (RCM) is the process of managing, monitoring, and improving practice revenues. The cycle is the repeatable process from taking a patient’s information through to collecting payment. In healthcare, these cycles can be protracted and complicated. Eliminating errors and inefficiencies can deliver bottom-line results.
Anesthesia revenue cycle management has a few of its own quirks and intricacies. If your practice administers anesthesia, it is important to understand the RCM process. The following are seven things you need to know about anesthesia RCM.
Your primary focus is on providing services to patients, the specifics of how charges are calculated may not be something you think about often. However, understanding this formula is essential for revenue and cost optimization. The following is the typical formula:
(Base Unit + Time Units + Billing Modifiers) x Per Unit Fee = Total Charge)
The base unit is an amount specified based on the anesthesia service provided. This is predetermined based on how the procedure was coded. The time units are calculated by the start and stop times of the anesthesia. This is based on the presence of the anesthesia provider, not the anesthesia itself. So, if an anesthesiologist is required to be present for a procedure, it is added to the time units.
There are a few modifiers that can impact the charge amounts. These include the patient status, medical direction, anesthetic used, and add-ons such as age and emergency. Your medical billing team must be intimately familiar with these modifiers.
As the above section indicates, there are some significant intricacies to anesthesia revenue cycle management. The difference between optimal financial health and poor revenue performance can often be in how well the provided service is documented.
Accuracy and specificity can help to ensure that you are billing and being compensated for the full extent of the service provided. Additionally, it can also help to ensure your success in the event of a disagreement on a charge capture with an insurance provider or patient.
One of the key benefits of anesthesia revenue cycle solutions is that it improves the visibility of your earnings in real-time. In other words, you can more easily monitor for errors, inaccuracies, and inefficiencies. This can help by giving you a chance to improve how you handle billing and payment collection. In some cases, you may also catch errors early, allowing them to be corrected.
This is also helpful if you ever need to provide the financial viability of your team. The data you need to demonstrate your value is already collected and organized.
Revenue control management is about more than just collecting from patients faster. It is also about ensuring that your incoming revenue is not prone to have erroneous billing and fraudulent claims.. Ensuring compliance is an essential element of this.
Poor compliance can lead to fines and litigation. Collecting a lot of revenue will not help your bottom-line performance if your processes are sloppy and lead to fines.
Insurance carriers may be reticent to pay claims. This can cause a tedious and frustrating experience. Getting organized about your insurance carrier relations can help you to ensure that claims are being followed up regularly. Good anesthesia revenue cycle management includes checking for aging accounts receivables and pursuing them until payment is made.
Additionally, you can examine the data on each insurance carrier. This will help you to identify which ones are repeat offenders for slow payments, payment refusals, and underpayments. Knowing this will help you to develop a strategy for working with those providers in the future.
The Medicare Access and Chip Reauthorization Act of 2015, often called MACRA, created a system called the Quality Payment Program. This unified PQRS, the Meaningful Use Incentive, and the Value Payment Modifier. The intention of this program is to improve reporting and compliance to improve efficiency and mitigate errors in coding and payments.
There are bonuses and penalties associated with this program. So, it can be in the best interest of eligible providers to invest significantly in ensuring compliance with these rules. Anesthesiologists and CRNAs are among those considered eligible providers.
As the above things to know make abundantly clear, revenue cycle management for anesthesia is no simple matter. The process involves extensive documentation and a strong understanding of regulations as well as insurance carriers’ policies and practices.
Fortunately, this can be solved with the right anesthesia revenue cycle management solution. Working with the right provider can mean that you get specialized tools and services for anesthesia providers. abeo is a medical billing services provider that understands the intricacies associated with anesthesia. Working with us will help you to maximize your incoming revenue and minimize compliance risks.
abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.