Anesthesia billing and accounts receivable

Anesthesia billing is time units plus base units plus modifiers, and a single missed start or stop time changes the whole claim.

Where the money leaks in anesthesia

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• Time units miscalculated from an incomplete anesthesia record
• Medical direction modifiers (QK, QY, QX, QZ) applied incorrectly
• Concurrency rules breached across overlapping cases
• Base units taken from the wrong ASA crosswalk year
• Post-op pain blocks bundled into the anesthesia claim

What a seat does about it

One trained person works your queue from the difficult end. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing.

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and certified coding at $2,500.

The codes those turn into

Each of these is a denial code you are likely to meet working anesthesia, matched to the problem above it in your own words. The route back to payment differs by code, so a queue sorted by recovery route clears faster than one sorted by date.

• CO-16 — Claim lacks information
  Something on the claim is missing or malformed. On its own the code tells you nothing — the detail is in the remark code that comes with it.
  Recovered by being corrected and resubmitted. Matched from: “Time units miscalculated from an incomplete anesthesia record”
• CO-252 — Additional documentation required
  The payer will not decide until it sees paperwork. Nothing happens until it arrives.
  Recovered by being answered with the document the payer names. Matched from: “Time units miscalculated from an incomplete anesthesia record”
• CO-4 — Modifier and code disagree
  The code and the modifier disagree, or a modifier the payer required was not there.
  Recovered by being corrected and resubmitted. Matched from: “Base units taken from the wrong ASA crosswalk year”
• CO-45 — Charge exceeds the fee schedule
  A contractual write-off rather than a denial. It only becomes a problem when the allowed amount is wrong.
  Recovered by being checked against the contract before any work is done. Matched from: “Post-op pain blocks bundled into the anesthesia claim”

Working a denied claim costs $57.23 per denied claim in administrative time (source), and about about 90% of initially denied claims are eventually paid. Most of what sits in a anesthesia AR bucket is not lost money. It is money waiting for somebody with the hours to make the call.

Questions