Surprise Medical Billing for Anesthesiologists

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Surprise Medical Billing for Anesthesiologists
Basics of Surprise Medical Billing Out-of-networ
k billing, or surprise medical billing, occurs
when a patient receives a bill for the difference
between the out-of-network providers fee and the
amount covered by the patients health insurance,
after co-pays and deductibles. These bills can be
unanticipated by patients, who often assume that
facility-based providers, including
anesthesiologists, are in-network because their
surgeon and hospital are in-network. Surprise
medical billing has affected one in five
Americans, amounting to 40 billion each year.
The problem can be caused by health insurance
companies who create narrow networks of health
care professionals, limiting patients access to
in-network physicians. Insurance companies may
seek to improve their profitability by refusing
to negotiate fair payment rates with
anesthesiologists and other physicians. Although
90 percent of anesthesiologists claims are
in-network, meaning patients dont receive
surprise medical bills, there is still cause for
concern. Some patients still face financial harm
from surprise medical billing, often due to
circumstances beyond their control. Surprise
billing is not only a problem for patients,
aggressive health insurance companies also harm
physicians practices as well. Anesthesiologists
must maintain the ability to negotiate fair
payment rates and resolve disputes in a fair and
balanced way in order to keep their practices
healthy.
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Surprise Medical Billing for Anesthesiologists
Preventing Surprise Medical Bills Coverage
report The easiest way to prevent surprise
medical bills is to determine eligibility for
major procedures as far in advance as possible.
Most of the time, front-end revenue cycle teams
are only able to work 2 to 3 days out to obtain
prior authorization from insurance carriers for
services like surgery, which leads to a scramble
and creates headaches like unexpected,
out-of-network charges for patients. You can also
use billing software or clearinghouse services to
determine accurate cost estimates and determine
the financial resources a patient will need weeks
ahead of the scheduled service. 2-3 days prior
patient visit, your front desk staff must be
ready with insurance coverage.   Training to
staff Your front desk staff must understand the
coverage report and should be knowledgeable to
explain the coverage report to the patient.
Well-informed patients are in a better position
to make decisions about planned visits. Your team
member must understand various components of
benefits reports like co-payments, co-insurance,
unpaid deductibles, procedure code wise allowable
amount, number of allowable visits, and, covered
procedure codes.
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Surprise Medical Billing for Anesthesiologists
Be transparent Be transparent ahead of time, as
early as possible with the patient on what they
should expect their bill to be, especially on
significant procedures or services. If required
provide the financial counseling. Financial
clearance is a process that determines a
patients ability and likelihood to pay, ensures
they are notified, and are prepared to
financially cover the cost of their
services. Updated guidelines Practices should
employ new strategies and processes to
proactively mitigate unexpected charges and
ensure compliance with new federal mandates. You
have continuous train your RCM team on payer
billing policies and reimbursement
guidelines. Medical Billers and Coders (MBC) is
a leading medical billing company providing
complete revenue cycle services. As a part of
complete medical billing, we share eligibility
and benefits reports for every patient visit. If
you are looking for eligibility and benefits
services or need assistance in medical billing
for your anesthesiology practice, contact us
at info_at_medicalbillersandcoders.com/888-357-3226.