Avoiding Anesthesia Billing Fraud

The clinical work of anesthetizing patients for surgery is merely the tip of the iceberg when it comes to anesthesia management. In the evolving healthcare environment in which we live, anesthesiologists and CRNAs must be knowledgeable about the business of anesthesia as well. As a facility administrator, you should be able to trust that your anesthesia management group emphasizes above-board billing practices and takes great care in avoiding anesthesia billing fraud.

How Anesthesia Billing Fraud Can Impact Your Facility

Although it is true that the Centers for Medicare & Medicaid Services (CMS) holds anesthesiologists and CRNAs personally responsible for anything filed under their NPI number, there is still risk involved for your facility in the event of anesthesia billing fraud. Even when billing services are outsourced, your facility could be named in any media headlines that may surface about the case. Rather than risk bad press, make sure your anesthesia management group is taking care of any anesthesia billing issues before they arise. There are numerous ways to avoid anesthesia billing fraud, including:

Complete, Thorough and Legible Documentation

Documentation is paramount in avoiding anesthesia billing fraud. Records should be complete, legible and personally signed by the anesthesia providers. Each encounter should include reasons, relevant history, exam findings, prior test results and a plan of care. If consistent errors are found, your anesthesia group should hold informative meetings with providers on proper documentation expectations. 

Streamlined Electronic Documentation

If your anesthesia providers are not using electronic documentation solutions, they should be. We have seen a significant uptick in documentation compliance among our client facilities where electronic charting has been introduced to the anesthesia department. Streamlined electronic documentation makes populating information and obtaining appropriate signatures infinitely easier.

Enhanced and Focused Regulatory Compliance Initiatives

As discussed earlier, it is important to ensure all services billed for are reasonable and necessary. It is also essential to maintain accurate and thorough documentation of all services. To ensure adherence to all compliance regulations, your anesthesia management company should be conducting periodic, random mock compliance audits of the anesthesia department. Our own Chief Compliance Officer, Dr. Steve Dorman, was previously a Joint Commission surveyor and CMS consultant. He routinely conducts mock audits for our client facilities and anesthesia providers and helps to educate them on regulatory compliance.

Addressing Anesthesia Time Issues

Documentation of anesthesia start and stop times should be accurate with no rounding. Time starts when the anesthesiologist or CRNA begins to prepare the patient for anesthesia care and time ends when the anesthesia provider is no longer in personal attendance. In cases of unusual circumstances that result in disparities between time for anesthesia services and the surgical procedure, documentation is key. Also keep in mind that anesthesia providers are not allowed to bill for discontinuous time. 

Using the Right Billing Modifiers 

There are a variety of anesthesia billing modifiers based on how your department is staffed at the time of the case. For example, the QY modifier would be used in a case in which an anesthesiologist medically directs one CRNA, whereas the QZ modifier would be used in a case in which a CRNA is providing anesthesia care without medical direction by an anesthesiologist.

Our Philosophy on Avoiding Anesthesia Billing Fraud 

CCI Anesthesia providers are regularly reminded that accurate and detailed documentation is an essential element of high quality and safe anesthesia care. Documentation procedures should be regularly reviewed to ensure all applicable regulatory, legal and billing compliance requirements are met. Our team of billing and compliance experts at CCI Anesthesia regularly examine documentation samples at each of our client facilities to ensure accuracy in coding. Additionally, our practice management teams monitor operational efficiency in real-time through our tablet-based EMR system, while our clinical informatics team maintains a constant watch on quality metrics. The end result for our clients is reduced costs, increased efficiency, improved quality and better clinical outcomes across their health system, hospital or surgery center.

Contact us today at 800.494.3948 to learn more about our customer friendly, compliance focused anesthesia service. Our practice management experts
are eager to help improve the performance of your anesthesia services.