Surprise billing is a universal problem in healthcare and perhaps nowhere more prominent than in anesthesiology. Arising from services unexpectedly rendered by out-of-network (OON) providers, these charges often create overwhelming financial hardship for patients. At the same time, anesthesiology practices are forced to absorb the loss or undergo costly, time-consuming arbitration processes to seek payment when balances are unpaid by patients or insurance plans. If your practice has concerns about surprise billing or the legislation governing it, abeo offers a closer look at how you can successfully navigate this issue.
Surprise billing occurs when patients unexpectedly receive medical services from OON providers. In most cases, this happens when emergency care is rendered and there is no time to determine whether the provider has a contract with the patient’s insurance plan. Anesthesiologists also experience an outsize impact in this area, because they are often employed in private practice rather than by a hospital or health system. Many patients are unaware of this and may not think to confirm a contract between their anesthesiologist and insurance plan. As a result, insurance providers often refuse to cover the billed charges, and patients can receive a large bill for the balance.
While most patients will not be affected by surprise billing, it remains a significant problem for the healthcare industry. According to research conducted by the Journal of the American Medical Association (JAMA), one in five patients has received a surprise bill in the last two years. Additionally, 18% of all emergency medical visits result in at least one surprise bill.
Today, the No Surprises Act protects patients from the impact of surprise bills, but numerous problems remain for anesthesiologists and other medical providers commonly affected by unexpected charges. As a result, practices may experience reduced revenues and find little recourse to seek adequate compensation from insurance plans.
Due to these complexities, practices with the greatest risk for surprise billing must develop strategies that balance the needs of patients with fair reimbursement. abeo recommends the following three-part approach to achieve equitable results for all parties.
Whenever possible, clear communication with the patient is key. Providers must remember that patients may not be well-versed in the complexities of medical billing. Additionally, concerns about affordability only add to anxieties surrounding the procedure they will receive.
If you are aware of a lack of insurance coverage before a procedure, do your best to address this with your patient. This allows them to schedule treatment at a facility with an anesthesiologist who has a contract with their insurer. Whenever possible, strive to clarify the post-procedure financial impact of treatment while ensuring patients you will do your best to meet their needs.
In many circumstances, you may be able to negotiate a more favorable reimbursement rate with the patient’s insurance provider. In fact, numerous insurance plans offer to match an anesthesiologist’s typical under-contract reimbursement rates when emergency treatment is required.
OON billing is often the only leverage an anesthesiologist has to ensure fair compensation from insurance plans they do not have a contract with. Unfortunately, the recent surprise billing legislation may limit your ability to use this tactic. Still, working with insurance plans can often lead to a positive outcome and more profitable reimbursement.
If you are unable to reach an agreement with the patient’s insurance plan, the patient himself could have more success. While the company may not be motivated to work with you directly, their commitment to member service could encourage a resolution for their client. Doing whatever you can to encourage and support your patient’s advocacy on your behalf may result in more appropriate reimbursement than would have otherwise been offered.
With clear communication and a strategy for seeking adequate reimbursement in place, your practice can successfully navigate the challenges presented by surprise billing. To find support for all the financial and operational issues affecting your practice, turn to abeo. Our medical practice management services help anesthesiologists lower costs, improve efficiency, and ensure compliance to promote growth and profitability. Contact us today to learn more.
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.