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Healthcare Compliance, Auditing Solutions. Technology, Risk-Based Auditing
Pitfalls in Anesthesia Billing Underscore the Need for Coding Compliance Risk Evaluation
November 8, 2017
BROOKFIELD, Wis., Nov. 6, 2017 /PRNewswire-iReach/ -- The rules for medical coding and billing change almost every year. Furthermore,unlike many specialties, the coding system used by anesthesiologists is much more complex. As a result,coding errors are far more likely to occur. The solution, says healthcare support and management industry leader Fi-Med Management, is applied technology that's used to find the source of any coding issues. Using this approach, problems can be corrected before any kind of corrective actions (audits, for example) occur.
Inmanyhealthcare organizations, administrative support staff in central billing offices (CBOs) handle most of the finer nuances of medical coding. Some medical specialties have only a small number of current procedural terminology (CPT) codes that are regularly used by providers, and medical coders in CBOs become very familiar with these codes. But for anesthesiology, this isn't the case. Anesthesiologists are on their own in figuring out how to properly code for their time spent in surgery. Unfortunately, this means determining which of the over 13,000 procedure codes applies to an individual case.(1)
Furthermore, anesthesiology is unique—a significant amount of provider reimbursement depends on the amount of time spent tending to a patient. Anesthesiologists must be able to calculate base units of time, which are numerical values determined by Medicare that are attached to certain anesthesia CPT codes. They also have to use specific conversion rates for total anesthesia time.(2)
Anesthesiologists are also responsible for using certain CPT code modifiers which are used according to the level of anesthesia supervision. For example, a surgery that's directly supervised by a single anesthesiologist would use one modifier, while a different surgery that involved both an anesthesiologist and a certified registered nurse anesthetist (CRNA) would use a different modifier.(1,2)
Any errors related to proper CPT code, surgery time, or who was present during the surgery can mean less reimbursement for services. As a result, medical care provided by anesthesiologists is undervalued, which can have a trickle-down effect that impacts the rest of the healthcare industry. On the other hand, errors can also result in significant overpayment, which exposes healthcare organizations to a greater risk of audits by recovery audit contractors (RACs).
Adrian Velasquez, president and CEO of Fi-Med, says, "The complexities involved in anesthesia coding and billing are enough to make anybody's head spin. Providers must have a higher level of coding skills in order to correctly bill for services, but many anesthesiologists don't have this knowledge. However, healthcare systems are implementing change by using analytic technology to identify coding problems within their records. This helps to show which providers are putting the organization at increased risk for compliance issues and audits."
To assist healthcare organizations in identifying compliance risk, companies such as Fi-Med offer risk-based auditing software, such as REVEAL/md, which evaluate billing records to determine which healthcare providers could increase an organization's liability. Hospital facilities and networks nationwide can help to correct coding problems by using these types of technologies, lowering risk and helping to retain value for the entire healthcare industry.
Since 1993, Fi-Med has been working alongside healthcare providers and networks to maximize revenue and reduce risk, from catching billing errors to providing high-level safeguards against compliance risk. Fi-Med is a healthcare technology leader helping to disrupt the status quo of the ever-increasing burden of government compliance for hospitals and hospital systems nationwide, by providing effective financial management and reporting services. Its strong reputation for maximizing revenue and reducing risk for hundreds of hospitals, labs, private physicians and healthcare networks is the direct result of its technology tools. REVEAL/md is Fi-Med's keystone product, empowering healthcare provider compliance departments with the ability to engage in proactive management of physician part B audits of documentation and coding. For more information, visit www.fimed.com
About Adrian Velasquez:
With a history of extraordinary successes in the healthcare field, Adrian E. Velasquez partnered with Christine Krause to form Fi-Med Management, Inc., in 1993. Their mission: to bring business acumen and compliance expertise to healthcare providers throughout the United States. They've become trusted experts in the fields of financial healthcare management, compliance and risk assessment, and chronic care management. Adrian's extensive experience as a system administrator and national healthcare consultant formed the foundation that he harnesses today for Fi-Med clients.
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