With regulatory changes inflating the cost to collect and declining reimbursement, many anesthesia practices are making the decision to outsource their revenue cycle management functions to a third-party vendor. As a part of this process, providers expect their billing partner to stay abreast of industry changes.
But how can anesthesia groups know that those expectations are being met? While there are many things your billing partner should be doing, three important things come to mind when I think about the key areas to safeguard reimbursement optimization.
Accurate coding is essential to ensure the maximum level of reimbursement for anesthesia procedures. The rules for coding and the codes themselves often change from year to year and payer to payer, and it is important to have processes that are specific to the intricacies of anesthesia services and not a general “one-size-fits-all” approach to all medical coding.
How is your company educating coders on industry changes? How is coding performance monitored? Are the coders certified in anesthesia and/or pain? Not only should regular internal audits take place, independent audits should also be performed annually to ensure coding is optimal and compliant. Annual provider education should occur to educate clinicians on how to address documentation deficiencies
2. Investing in their information technology infrastructure
Many hospitals have transitioned to an Electronic Health Record, although the anesthesia rollout is typically last on the list. This transition has transformed the process from being paper-based to electronic-based over the past 5 years. This movement towards an EHR requires an RCM vendor to have a a robust information technology (IT) infrastructure and the ability to the vast amount of secure data being transferred through interfaces from the hospital, clearinghouses and payers.
Are you confident your information is safe? What redundancies are in place so data is always accessible when needed so billing is not delayed? The IT support team needs to make sure systems are capable of handling the rapidly changing developments in healthcare. Has your billing company met the requirements of HIPAA HITECH?
3. Providing analytics to understand your practice
With all the data flowing in and out of the billing system, what is your RCM company doing with that data to improve performance, monitor payer contracts and payments, minimize denials, ensure compliant coding and accelerate the billing cycle? Are you receiving actionable data to gain a better understanding of your practice and the market you’re serving? Are you aware of shifts in payer mix and seasonal trends so that you can position the group to mitigate risks and capitalize on favorable trends?
Collecting and reporting of quality data can be daunting and costly for an anesthesia practice Is your billing partner providing you with a free, user-friendly platform for the capture of quality measures?
If you were to ask your billing company the questions above, would you be confident in their responses? What are their plans for maximizing your reimbursement with compliant practices now and in the future? What investments have they made in information technology and infrastructure and how will they keep your data secure and that of your patients? Are they providing you with actionable data to make sound financial decisions for your practice?
Contact us today if you’re looking for a revenue cycle management partner and are interested in learning more about R1’s services.
Jeanette Mini is the Regional Vice President of Sales for the Anesthesia Business Unit at R1. In this role, Jeanette is responsible for coordinating all supplemental client support activities including special reporting, third party audits & strategic planning initiatives.