The anesthesia marketplace is unique, complex — and constantly evolving. Because of its intricacies, many healthcare organizations have outsourced their anesthesia departments and billing to external vendors. Recently, however, some organizations are choosing to bring that function back in-house.

Across the board, healthcare leaders recognize the need to maximize anesthesia revenue amid declining reimbursements and shifting regulations. Yet many organizations still leave money on the table by not optimizing their anesthesia revenue cycle.

To explore the challenges and opportunities in this space, Becker’s Healthcare spoke with two experts from North American Partners in Anesthesia (NAPA): Rhett Lankford, Senior Vice President and General Manager of Managed Services, and Lynn Van Houten, Senior Vice President of Revenue Cycle Management.

Navigating the unique complexities of anesthesia billing

Anesthesia stands alone in the medical realm as the only specialty to rely on time-based unit coding and American Society of Anesthesiologists (ASA)-specific billing guidelines.

As Ms. Van Houten explained, anesthesia billing requires a dual-layered approach: aligning CPT codes derived from the surgeon’s notes with a separate set of ASA codes unique to the specialty. This process is further complicated by the need to accurately track, apply, and document the seven elements of medical direction, a critical factor in anesthesia reimbursement. In addition, concurrency needs to be considered, where precise start and stop times across multiple cases are required.

“Different payers use different methodologies for this,” Ms. Van Houten said. “Some use 10-minute increments, others use 15 or even 12. Rounding rules also vary between payers, which is why it’s critical that the RCM system is configured to calculate billable units precisely, down to the minute, in alignment with each payer’s specific guidelines.”

All timing data must be entered into billing systems so concurrency reports can be generated accurately. “Concurrency drives modifier usage for anesthesia, which directly impacts reimbursement,” Ms. Van Houten said. “We can’t bill payers until we get the provider’s entire day of work and run it through concurrency.”

To truly optimize anesthesia RCM for both performance and compliance, leaders must look beyond traditional revenue cycle metrics. This means focusing on time unit accuracy, concurrency management and modifier application, as well as benchmarking across regions and payers.

Alignment between clinical teams and RCM is also essential. As Ms. Van Houten noted, many RCM departments still operate in silos. “In anesthesia, revenue cycle success depends on accurate documentation and a deep understanding of clinical care team approaches,” she said. “With this understanding, we can ensure both accurate billing and strong compliance.”

Why non-specialized RCM vendors miss the mark

When health systems outsource anesthesia RCM, they often encounter two major issues. First, outsourced RCM teams are typically staffed with generalists who don’t understand the uniqueness and complexities of anesthesia billing.

Second, many vendor systems are not built to manage anesthesia-specific needs. For example, systems may not support concurrency or document the seven elements of medical direction. According to Mr. Lankford, these gaps result in inaccurate coding and billing, which leads to a tremendous amount of revenue leakage.

Billing nuances can also vary by organization type. Academic medical centers and teaching hospitals, for example, face additional requirements for billing anesthesia fellows, subspecialists, student CRNAs and student anesthesiologist assistants. NAPA’s systems are specifically designed to support these variables, as most RCM platforms cannot do so without significant modifications.

“Academic centers, in particular, often miss out on revenue due to inaccurate coding and billing for providers overseeing students,” Mr. Lankford said. “General RCM vendors don’t handle anesthesia billing well, and internal RCM teams often aren’t prepared to handle it correctly, either.”

Taking a holistic approach to maximize revenue and prevent leakage

The NAPA Managed Services team looks beyond RCM to optimize the entire anesthesia operation. The team helps hospitals and health systems deploy labor more effectively, maximize clinicians’ time and increase reimbursements.

By removing operational and administrative burdens, NAPA allows clients to focus fully on clinical quality and patient outcomes.

Mr. Lankford explained that NAPA’s approach is built on three integrated pillars: the clinical aspect, RCM and payer contracting. “At many organizations, those pillars operate independently,” he said. “If the payer contracting team isn’t seamlessly integrated into the RCM function, you lose a lot of efficiencies and revenue capture. Mistakes in billing can also lead to compliance issues.”

NAPA also invests in a fully onshore workforce to enhance patient and client experiences. Its Patient Advocacy Center of Excellence, for example, is staffed entirely in the U.S. to handle nuanced patient questions about anesthesia claims.

While other companies may offer RCM point solutions, NAPA delivers a comprehensive continuum of integrated anesthesia services.

“We create deeper value through a holistic, end-to-end solution, rather than simply offering revenue cycle management services,” Mr. Lankford said. “That’s a key market differentiator for NAPA. We think that’s where the market is going, and we want to be at the forefront of that shift.”

The post The Anesthesia RCM Advantage: How Specialized Expertise Drives Revenue and Compliance appeared first on Becker’s Hospital Review | Healthcare News & Analysis.