Understanding How Anesthesiologists Are Underpaid Is Key to Fixing the Problem

Originally published by our sister publication Anesthesiology News

Anesthesiologists face unique challenges with major pitfalls when billing for the care they provide, according to a session at the American Society of Anesthesiologists ADVANCE 2024: The Anesthesiology Business Event.

“I explain the differences between what anesthesiologists charge and what they get paid because they’re two different things,” said Kelly D. Dennis, MBA, an anesthesiology billing consultant at Perfect Office Solutions Inc., in Leesburg, Fla.

The two main issues that threaten the viability of anesthesiologists’ practice are public undervaluation of care and inaccurate billing. Public undervaluing of care is known as the “33% problem” and refers to the fact that Medicare payment rates for anesthesia are roughly 33% of average commercial payor rates. However, in some states, reimbursement rates are even lower. This is in contrast to an average 80% reimbursement of commercial payor rates for other specialties.

Another key aim of the session was raising awareness of this issue. Sustained and widespread pressure on legislators from anesthesiologists has the potential to remedy this problem, according to Dennis.

Even when billing private insurers, anesthesiologists face a complex billing environment that is based on base hours and the complexity of each procedure. Dennis laid out the contours of the billing process and emphasized that doctors must have at least a rudimentary understanding of how claims are filed to ensure they are compensated correctly and don’t expose themselves to claims of false billing or failing to bill for services they provide.

“One of the top mistakes anesthesiologists make—that they can correct—is capturing the documentation elements coders rely on when reporting,” Doris V. Branker, CHC, the president of DB Healthcare Consulting and Education LLC, in Miami, told Anesthesiology News. “Examples are time documentation and key details that allow their reports to stand alone.

“Communication with revenue cycle staff is also critical for anesthesiology groups to survive, as they often don’t notice an issue until a drastic change in revenue occurs and this is often too late for correction,” Branker concluded.

By Myles Starr

Branker and Dennis reported no relevant financial disclosures.