Minimizing claim denials is the goal of every medical biller because denied claims represent delayed or lost revenue. With proper processes and workflows in place, your medical billers can quickly and effectively avoid or resolve denials that directly impact your billing costs and revenue.
Below are the best practices to proactively reduce claim denials.
What makes billing for anesthesia services more complex than other specialties is its unique payment system that includes:
The formula for reimbursement for anesthesiologists or CRNAs:
(Base Factor + Total Time Units) x Anesthesia Conversion Factor x Modifier Adjustment
For anesthesia performed under medical direction:
[(Base Factor + Total Time Units) x Anesthesia Conversion Factor] x Modifier Adjustment
These fundamentals show how anesthesia billing is not your run-of-the-mill medical billing. You can avoid denied claims by having a basic understanding of how anesthesia care is provided and knowing the best practices in anesthesia medical billing.
Different types of anesthesia have unique billing codes, which can be confusing for billers who lack an understanding of anesthesia services. Knowledge, coupled with clear and accurate documentation of codes and modifiers, can help avoid confusion.
Modifiers are required to be added to procedure codes when billing. They are two-character indicators that signify relevant details, like age, physical status, and emergency factors on a claim. When billers are unaware of proper modifier usage, the result can be inappropriate billing and denied claims. The correct modifiers and codes are essential to ensuring consistency and accuracy in reimbursements while remaining compliant. They also avoid unbundling and duplicate billing.
The Healthcare Common Procedure Coding System (HCPCS) indicates modifiers specific to anesthesia services and are standard on claims submitted to Medicare and many other payers.
When claims are denied, the biller performs a root-cause analysis to identify issues that need correction. Once the reason for the denial has been identified, the biller proceeds with the following actions:
Following up on denied claims helps you run your facility smoothly and successfully, as you ensure every owed amount is received as quickly as possible.
When following up, ask the following questions and record the responses:
Is your facility looking for ways to get paid for pending or denied claims? This is where a dedicated A/R follow-up team can benefit you.
An outsourced anesthesia medical billing team tracks and manages each claim and provides complete, real-time visibility of your cash flow. Your billing partner’s A/R follow-up and denial management team are in charge of investigating rejected claims and reviewing them to collect maximum compensation. They will have the knowledge, experience, and tools to ensure you receive the last dollar you are owed.
At Coronis Health, we utilize denial management software designed to monitor claim status, allowing us to increase the first-pass rate significantly. By staying abreast of medical billing trends, future denials are avoided before they can happen, allowing your facility to collect timely payments for services provided. We analyze denied claims to help you create better workflows with services such as coding deficiencies, appeals, authorizations, and more.
Our thorough and meticulous approach to collection gets results. With our decades of experience providing tailored solutions, we can ensure your collections are efficient, and denials are kept to a minimum. To learn more about how you can benefit from our anesthesia medical billing services, contact Coronis Health to request a free financial check-up.
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