Case Study: Anesthesia billing and coding rigor improves reimbursements
Customer Situation
Our client, an IOWA-based anesthesia practice operating from 3 locations with 12 anesthesiologists in the group, was facing increased denials due to preventable causes. Anesthesia procedures are unique and require specific diagnosis codes. Hence, the quality of documentation by the Anesthesiologists plays a critical role in reducing coding-related denials.
Challenges
Medical Billing Wholesalers team of revenue cycle practitioners and managers analyzed the trends in denials and identified the following issues that led to many rejections and denials, causing delays in cash flow.
Illegible handwritten notes without complete documentation of diagnosis
E.g., when the handwritten notes are unclear, the coder would not be able to conclude whether the procedure was performed on the upper or lower abdomen since the base unit for the upper and the lower abdomen procedures vary.
The billing and coding team members must seek clarifications on unclear handwritten notes to be able to bill and code accurately. These clarifications further increase the clinician's time on billing and coding support.
If not coded to their highest specificity, diagnosis codes cause denials and reduced reimbursements.
Missing guidance documentation led to reduced reimbursement rates.
Filing of the guidance codes individually provoked more rejections and denials.
It wasn't easy to arrive at the exact anesthesia procedure codes.
There was a delay in the billing process due to the increased number of clarifications, which led to charge lag and an increase in AR days.
Missing more specific diagnosis codes can cause errors and increase denials and rejections. Handwritten diagnoses by the providers on the anesthesia check sheet led to coding errors with diagnoses not coded to their highest specificity.
Most of the practice's medical records did not have the required image guidance.
Solution
When the practice outsourced the processes to Medical Billing Wholesalers, we developed a comprehensive revenue cycle transformation plan involving comprehensive audit, solution development, and rigorous execution. Some of the solutions implemented are listed below:
Medical Records Audit
Reviewing medical records to check the accuracy of coding
Keeping the claims on hold if the MR is not complete - for instance, when it does not support the diagnosis of the highest specificity or if the image guidance is missing
Discussed the importance of scanning the detailed operative reports to arrive at the more specific diagnosis
We educated the providers in the group on the commonly used guidance and explained to them the importance of documenting the guidance details for sooner filing and reimbursement.
Analyzing physician-wise trends to make sure that we are sharing the details with the provider on the claims which are pending for additional details
Holding claims for clarifications
Keeping the claims on hold until the provider provides the LCD payable diagnosis to avoid denials and unnecessary follow-up
Insights regarding the issues in medical records were shared with the providers as and when required to avoid recurrence and improve the clean claim ratio.
Result
We were able to streamline the documentation processes completely. Consequently, we brought the number of accounts pending for specific diagnosis from 20% in Mar-21 to less than 3% in Dec-21.
We reduced the number of accounts pending image guidance from 10% in Mar-21 to less than 1% in Dec-21.
We brought issues related to Medical records under control and improved the clean claim ratio significantly.
As a result, the average monthly collection increased from $68,000 to $79,500.
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