Conditions For Payment Of Medically Directed Anesthesia
In my previous article regarding anesthesia billing practices, I neglected to mention another risk associated with overbilling for medically directed anesthesia. Engaging in the described practices tends to raise issues beyond the “double billing” issue that is directly raised. This type of issue can also raise further scrutiny of the source bills. For example, an insurer may decide to perform an extended audit of billings as a result of the billing anomalies that I described in my previous article. The review might disclose a systematic problem documenting all of the prerequisites that permit the billing for medically directed services.
In order to bill medically directed anesthesia services, seven primary elements need to be clearly indicated in the medical record:
If one or more of these elements is not indicated in the medical record, the claim may be denied altogether, sometimes for both the physician and the CRNA services. The physician alone is responsible for documenting each of these activities in the chart. Like everything else, if it is not in the chart, it did not take place.
You can see how the originally risky billing practice could trigger a further audit and in turn uncover deficiencies in documenting the conditions for medically directed reimbursement. If a systematic error is made in documenting the seven elements, there can be significant additional financial exposure to the group.