In anesthesia practices, your revenue is totally dependent on your billing process. You may have the best Anesthesia Care Team with high case counts but your cash flow is decreased without a proper anesthesia billing solution. How do you ensure the maximum dollar amount is collected on every claim?  It’s critical to ensure that these processes are as close to optimal as possible.

Anesthesia practices typically have two options: In house billing, or outsourcing their anesthesia billing. Some anesthesia practices opt for handling their billing in-house and at first glance this can seem cheaper than outsourcing. Why pay a set percentage or pay per procedure when you can bill yourself? On the surface it appears less expensive and provides more control.

If you plan to do your billing in-house there are a few aspects that many anesthesia practices do not think about until they have already made the decision to do their own billing. In this article, we will cover some characteristics of in-house billing that you need to understand and consider prior to committing to an in-house option:

1. More responsibility – One of the allures of in-house billing is more control. With more control also comes more responsibility and more risk. Dealing with large dollar amounts, HIPPA protected data, multiple insurance companies, and continually changing regulations increases risk and liability.
2. It is not a simple invoicing system –When it comes to anesthesia billing, you cannot use one-size-fits-all billing software. Anesthesia billing involves CPT-codes, HIPPA, hospitals, insurance companies, clearing houses and constantly evolving guidelines. It is a complicated and hard process that needs to be specific to anesthesia practices.
3. Infrastructure Setup – To start in house billing, there will be a significant investment in infrastructure. Do not underinvest in this infrastructure – any short-term savings will cost you more in decreased revenues and increased risk of compliance errors. Infrastructure setup includes purchasing and maintaining the required technology systems both hardware and software, as well as the cybersecurity and HIPPA compliance aspects. You’ll need to enroll and be credentialed with all the commercial payers you have contracts with in addition to Medicare, Medicaid and any additional local government payers. Having the most up to date anesthesia specific coding guidelines will be extremely important and it will be imperative to keep these items current and staff trained on recent changes.
4. Additional Staff – Most Anesthesiologists don’t have office staff, so billing in-house generally requires hiring additional employees and possibly renting office space. Once you hire your in-house billing employees they must be trained and supervised. Who is going to manage the billing employees? Remember, these employees will also have to attend continuing educational training on coding of claims. They will most likely get salaries + benefits, vacation time and sick days. What if a key-person leaves, who will back fill a very important part of your revenue cycle management team?
5. Negotiating Contracts – Who will be negotiating the hospital and payor contracts? Will you be doing that? Or will your new staff be doing that? Do they have the deep understanding and knowledge of how these contracts work to ensure that you are getting the most revenue for your practice?
6. Up to Date Training – The billing employees need to have anesthesia specific expertise, and will need to attend anesthesia-specific training to effectively bill and maximize collections. Regulations constantly evolve, and your billing staff needs to stay on the cutting edge of billing regulations.
7. Possibly Lower Revenue – Anesthesia billing is hard and complicated. A significant investment in people and systems is required for optimal anesthesia billing. After all of this time, money and effort – how much of the revenue that you worked so hard for never gets collected? Fusion Anesthesia, an anesthesia billing company with over 45 years of anesthesia specific billing experience, says that they generally increase the overall revenue of an anesthesia group by 5-10% and have seen as high as 15% increases as compared to what the previous in-house team was collecting.
8. Is in-house billing really cheaper? So far, we’ve covered renting office space, hiring employees to process claims, hiring someone to manage and supervise the billing team, salaries+benefits+time off, continual education and training, purchasing the technology to perform the billing, and liability risks. Still with all this money and effort, it can be frustrating to realize that 5-15% of the money is still left on the table. Will the decision to do in-house billing increase your bottom line? Or is it a lot of risk and investment, to lower your total cash flow and revenue?