Hospitals and health systems are facing more competition and belt-tightening than ever before. The financial impact of bundled payments, the increasing costs of staff and supplies, and rising drug prices mean that hospitals need to maximize their revenue wherever it’s appropriate.

Hospitals that utilize a single service for all of their billing, whether contracted or in-house, rely on systems and expertise that have been optimized to maximize revenue across every department and specialty. That’s ok as far as it goes, but it means that they are not optimizing billing and collections for some specific specialties with outlier requirements– like anesthesiology.

Wondering if your anesthesia billing department is already maximizing revenues? Here’s a quick way to check: look at a line-by-line reconciliation for the past six months. If it doesn’t exist or if it doesn’t show that a significant percentage of the claims for payments were kicked back because they didn’t meet your contracted rates, then you’re almost certainly being short-changed by payers.

A specialized anesthesia billing agency can increase collected revenue in anesthesiology by as much as 5 to 15%.

What’s worse than losing out on legitimate revenue?
Regulatory compliance problems and allegations of fraud from accidental overbilling. Accidental overbilling is all too common when general coders try to handle the complex work of anesthesia billing without specialized software or anesthesia coding skills.

As an example, Epic Systems was recently sued for “inducing” numerous clients of their EHR system to fraudulently double-bill anesthesia services to Medicare and Medicaid by hundreds of millions of dollars. Reportedly, Epic’s software default settings led to charges being inappropriately calculated. It appears that a 30 minute, 4 base unit procedure would have been billed at 34 Units (4 base units + 30 minutes), rather than billing correctly at 6 Units: (4 base units + 2 time units) = 6 billing units

This is a simple mistake by the programmers. However, the fact that it went unnoticed by general billing “experts” for so long is testimony to the specificity of knowledge needed for billing anesthesia services.

In addition to losing revenue, using a generalist billing service can put hospitals at risk for regulatory issues such as overbilling.

The real problem is in treating anesthesia billing as a commodity service without specialized oversight. Epic’s prestigious multi-facility health system customers were committing fraud on a massive scale with the best of intentions. Epic and their customers are great organizations with world-class people and technology. The people they had assigned to revenue cycle management were undoubtedly experts in health care billing systems…. but they didn’t truly understand anesthesiology billing.

“General” billing systems will work well for 90% of the billing situations that your hospital faces… but not for anesthesiology.