The Formula for Anesthesia Billing Success

March 27, 2024

Anesthesia billing is unlike any other specialty and has peculiar rules. Knowing these rules is helpful. Premier Anesthesia does anesthesia billing full-time and we do it better than others who don’t. Most specialties are reimbursed by the volume of encounters or office visits, but anesthesia billing and collections is uniquely complex. Even for those of us that work in anesthesia every day it can be difficult to explain the intricacies.

Risk & Time
Anesthesia is billed and reimbursed based on risk and time and uses a formula with many variables. The result is that there is not a set price for specific procedures. Two patients can have the same procedure in the same facility covered by the same payor and yet anesthesia reimbursement will be different.

Anesthesia reimbursement is based on units, which is a combination of base units and time units. Think of base units like RVUs. Each procedure type is assigned a number of base units based on the risk of the procedure. The formula adds time units and also allows for adjustments for each specific patient’s physical status and other qualifying circumstances, like emergency surgery. Most payors reimburse time units in 15-minute increments. The formula is:

Base Units + Time Units + Patient Physical Status Units + Qualifying Circumstances Units = Anesthesia Charges

Non-Time Based
A portion of anesthesia billing is based on flat fees based on the payor. Epidurals, c-sections, peripheral nerve blocks, and arterial and central lines are examples of procedures that are billed using flat fees instead of the unit-based formula.

Anesthesia Modifiers
To further complicate things, there are a number of billing modifiers. There are various billing modifiers based on whether an anesthesiologist or a CRNA self-performed or independently administered anesthesia, or if an anesthesiologist and an anesthetist both worked on the case. If both work on a single case, there are at least three sets of modifiers that can be applied: Medical Direction, Medical Supervision, and Not Medical Direction (QZ). The first two sets of modifiers generate two claims, one for the doctor and one for the CRNA.

Medical Direction
The rules for medical direction are very strict. First, anesthesiologists cannot direct more than four cases at any given time, but more importantly, they are required to follow seven specific rules. These rules mean that Medical Direction carries a higher risk of non-compliance that does not exist for Medical Supervision or Not Medical Direction (QZ) billing.

Anesthesia Management Solutions
Premier Anesthesia is a single specialty anesthesia management company with a 22-year track record of providing efficient, high-quality anesthesia management solutions to hospitals and surgery centers across the US. We keep anesthesia billing and collections in-house because it’s so complex.

Anesthesia-Specific Tools, Processes, and People
Our affiliate billing company bills for 70 practices in 17 states. The systems we use are anesthesia-specific. The MedSuite billing platform is the most widely-used platform in the anesthesia billing and collections industry and generates robust reporting. MedSuite also captures quality data that allows us to report MIPS measures to maximize value-based reimbursement. Our team of certified billers and coders ensures fast and compliant revenue collection. At the same time, we tailor our accounts receivable services to each facility’s needs, from verifying insurance payments to handling denials and follow-ups. Most importantly, we see ourselves as a growth partner, helping identify missed revenue opportunities and new service opportunities. If you’re interested in learning more about our custom solutions to increase anesthesia revenue for your hospital or ambulatory surgery center, let’s connect.