The Value of Updating Your Practice on Anesthesia Documentation
Summary: As your billing company, we work hard to schedule and conduct documentation in-services. These sessions are critical in that they provide a unique opportunity to see billing guidelines in context and promote better documentation habits, ensuring optimal billing for services provided. Unfortunately, these sessions are often underattended. This can prove problematic in both the short and long term as continuing documentation deficiencies greatly hinder the claim submission process.
As your billing partner, we encourage all our clients to participate in documentation in-services on an annual basis. We believe these are an important component of an effective compliance plan. Unfortunately, participation in such scheduled sessions is sometimes less than optimal. Based on this reality, it is worth reviewing the rationale and intent of such sessions and the careful consideration that has gone into their preparation.
It is the business of your billing team to prepare and submit claims for the valuable professional services you provide. Since a claim is a request for payment, it must accurately reflect the actual services provided. Although there are diverse payer requirements and many coding and calculation guidelines that must be carefully considered in the process, ultimately each claim is only as accurate as the information provided by you, the clinician. We have a saying in this business that if you have seen one anesthesia practice, you have seen one anesthesia practice. This applies not only to the diversity of our client base but to the practice and documentation idiosyncrasies of each of our client providers.
Making sure that we get all the necessary details of each service so that we can prepare an appropriate claim is no small feat. If every provider presented us with complete and accurate records, the process would be much easier; but this is simply not the case. As one client said at a recent session, what you share with us today may well be forgotten by some of our members by tomorrow. Given that consistency is our goal, herein lies the problem. It is no different than the frequent reminders of current Covid-19 health guidelines. Some people get it, some don't and others don't want to.
A Unique Preparation
The sessions, which are now provided via on-line video, are carefully prepared to summarize the key components of anesthesia billing as concisely and compellingly as possible. Our presenters have considerable experience focusing the attendees on the key issues and engaging them on confusing points. Most will tell you that they always get something out of each session. There are always details they may have forgotten from previous sessions or subtle changes that may have been added. At the end of each session, we ask if it has been a valuable use of participant's time; and, without exception, the answer is yes.
Why then, do so many providers choose not to participate? That is the question our clients should be asking their members. The time investment of one hour is minimal to ensure that he/she knows what the critical documentation requirements are so that claims will be paid without question or delay. The importance of these sessions is why we go to such lengths to schedule sessions at times that are convenient for our clients.
A Unique Specialty
The reality is that anesthesia billing is unlike that of any other specialty where claims are simply based on CPT codes and are paid based on payor fee schedules. For years, many payers did not really understand the details of an anesthesia claim and would simply pay a percentage of the charge. This is no longer the case with the majority of payers. Payor guidelines now address each aspect of the charge in unique and sometimes confusing ways.
Getting paid for nerve blocks for acute pain management is a case in point. Knowing when the block performed meets the CPT criteria is only the first step. Some blocks, such as the IPACK block, have yet to be vetted by CPT and are unlisted—meaning the chance of getting paid is quite low. The block cannot be the primary mode of anesthesia. The use of ultrasonic guidance (USG) is payable so long as the image is retained and available for audit and the use of USG is justified. In other words, very specific documentation guidelines have to be met for the charge to be included on the claim.
Many clients have migrated to electronic anesthesia records, which can generate very complete and legible pdf files for each case. Because of the sophistication of the EMR, most providers assume that such systems make their record keeping fool-proof. Nothing could be further from the truth. When a hospital buys an EMR package, it is a generic solution that inevitably must be customized to meet the specific needs of the anesthesia practice. In-services provide a very useful format for evaluating whether all the necessary billing considerations have been taken into account.
A Unique Opportunity
Most of the interaction between our clients and the billing staff is transactional and focuses on isolated cases and scenarios. Rarely does it pull the lens back to address underlying policy issues. This is exactly what our documentation in-services are intended to do. They put charge policies in context. They identify potential risk areas and billing concerns and may include specific documentation deficiencies. It is an important aspect of practice management that is all too often overlooked.
The bottom line is that these carefully prepared documentation in-services are designed to reduce your compliance risks and increase your capacity to capture revenue that you may be currently leaving on the table. We think it's well worth an hour of your time. If you would like to schedule a documentation in-service for your group, please contact your account executive. Having said that, we realize that some of our readers are not currently part of our clientele. If your present billing solution does not provide value-added services, such as the documentation in-services described herein, we invite you to consider joining our client family. Email us at info@anesthesiallc.com. Anesthesia providers are our primary focus.