By Joe Laden, Vice President of Client Management
There are many misconceptions about anesthesia reimbursement, but most stem from one core issue – the widening disparity between rising anesthesia personnel costs and inadequate third-party reimbursement.
In a recent Becker’s ASC Review Q&A article, Dr. Jay Weller, a Health Prime client from Seven Hills Anesthesia, highlights this conundrum by describing the “gap” between anesthesia provider expenses and revenue from patient services. Due to a national shortage of anesthesiologists, salaries for anesthesia personnel have risen, while third-party reimbursements have remained static or declined, magnifying this gap.
The financial burden of funding the gap often falls on hospitals and surgery centers that rely on anesthesia staff to deliver surgical services, which are often the economic lifeblood of their organization.
Independent anesthesia practices must act to mitigate the effects of the gap, or they risk being replaced by the hospital or surgery center.
Following are suggestions anesthesia groups can follow to reduce the impact:
- Increase OR utilization
Work closely with the facility to improve operating room utilization, thereby reducing the anesthesia staff required. Although facilities typically strive to optimize utilization, this can be challenging when driven by surgeon scheduling preferences. - Negotiate higher reimbursement rates
When renewing contracts with commercial insurance payers, negotiate higher rates. This is becoming increasingly difficult, as payers employ strategies – like those noted by Dr. Weller – to reduce reimbursement. Success requires advanced negotiation techniques supported by detailed historical data, which can be obtained from the anesthesia group’s billing company database. - Maximize collections per case
Partner with your billing company to identify ways to increase collections per case. Challenges include new denial tactics from payers, unnecessary requests for medical records, and higher patient deductibles – necessitating improved patient collection processes. Despite these challenges, every additional dollar collected helps close the gap.
When working with the billing company to identify improvements, start at the anesthesia record and extend through the entire revenue cycle management process. This will include coverage discovery, denial prevention, denial management, and targeted follow-up techniques. Utilizing advanced patient receivable collection methods following insurance payment should also be implemented.
It’s imperative the practice collaborates with its billing company to identify incremental improvements that can collectively yield significant revenue gains.
Key takeaway
Closing the gap requires a coordinated effort across hospital partnerships, payer negotiations, and billing performance. If your current billing partner isn’t delivering the results you need, it may be time to find a high-performing RCM company.
Independent anesthesia groups that fail to demonstrate meaningful progress risk losing their autonomy – potentially being replaced by employed anesthesiologists or absorbed into a national group.
Health Prime can optimize your anesthesia group’s revenue cycle. To learn more, please send us an email or visit us at hpiinc.com/anesthesia.
