As ASCs confront an escalating shortage of anesthesia providers, many leaders and physicians are reevaluating the way they manage their anesthesia billing processes.
Here are three things ASCs should consider when rethinking their anesthesia billing processes:
1. Strategically target Medicare reimbursements
With more Medicare-eligible patients entering the healthcare market each day, Scott Mayer, CEO of Rosemont, Ill.-based Ambulatory Anesthesia Care, is working with outpatient centers to help them better isolate and manage their Medicare billing processes from their overall cost for anesthesia.
“I feel like people are lumping these bigger, kind of macro situations of, ‘Oh, we need to pay [for] anesthesia …’ when, really, we’re not looking at the root of the problem, which is Medicare reimbursement driven on the anesthesia side, and that utilization needs to be increased as well,” he told Becker’s
2. Full anesthesia ownership and operation
“An actionable solution to this growing problem is for an ASC to assume full control of its fate by owning and operating its own anesthesia business. Direct ownership of this critical ancillary service in an ASC allows cost containment, coverage stability and the highest possible [net promoter score] from patients,” Angela Durham, vice president of ancillary services at US Heart and Vascular in Franklin, Tenn., told Becker’s.
Ms. Durham said direct ownership allows anesthesia providers to become more permanent members of the ASC team, which benefits other providers at the ASC and helps contain costs.
“This solution allows an ASC to absorb only the direct costs related to anesthesia coverage and avoid the mark-up generated by the third-party, external staffing agency. Agencies pay their providers high premiums and operate without scale, resulting in high, unsustainable, administrative, overhead and billing fees being passed through to the ASC by way of unaffordable subsidy charges,” she added. “ASC owners should position themselves to sustain operations independently without the threat of unpredictable added cost resulting from the use of a third-party group.”
3. Identify “hidden revenue killers”
A March 15 blog post by Knack RCM identified several factors in anesthesia billing processes that frequently lead to revenue losses. These included:
- Time-based billing complexity: Unlike most specialties, anesthesia billing is time-based. Payers differ in how they calculate time units — Medicare uses decimals, while some commercial plans round to whole numbers — creating added complexity.
- Charge capture gaps: Ancillary services like nerve blocks or central lines fall outside time-based billing. Without proper documentation, these services often go unbilled, leading to lost revenue.
- Coding complexity: Billing requires precise use of base units, time units and modifiers for factors like patient age or comorbidities. Mistakes or omissions can trigger denials or underpayments.
- Modifier confusion: Modifiers play a key role in billing, but vary according to payer. Misuse can result in denials, audits or delayed payments.
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