Best Practices in Medical Billing

By July 6, 2018Uncategorized

As health insurance reimbursement mechanisms become increasingly dense and complicated, it is essential for healthcare management companies to focus on a cornerstone of the practitioner experience in a medical episode: billing. Billing refers to the complex set of codes that a healthcare practitioner must submit to the hospital’s electronic medical records system in order to (a) record in a standardized system the services and procedures rendered during a patient’s stay in the facility and (b) submit for reimbursement from the patient’s insurer or, if uninsured, by the patient him/herself out of pocket. Medical billing is under increased focus from anesthesia management companies as the rules and regulations shift under Center for Medicare and Medicaid Services (CMS) for advising how to treat such issues. Similar to coverage policies, the standards for medical billing under CMS often directly influence that of commercial payers. Therefore, when delving into the issue of medical billing it is often helpful to base management on the foundation of national systems, in order to build from the most stringent criteria to that which may be less rigid in practice.

As a precondition for selecting the correct code in medical billing, it is necessary to identify the practitioner who enacted the service or procedure on the patient. Moreover, the billing code should also distinguish between the practitioner — including an anesthesiologist, certified registered nurse anesthetist (CRNA), anesthesiologist assistant (AA), registered nurse (RN), or nurse practitioner (NP) — who enacted the procedure. CMS provides several categories to assist anesthesia administrators with forming such a distinction, based upon input from the clinicians themselves. The predominant categories are: teaching, personally performed, medically directed, and medically supervised. The first two are fairly self-expla