Keep this formula for reimbursement handy.
Anesthesia billing is a process that involves several components, one of which is the calculation of time units. Accurate anesthesia time unit calculation is essential for proper reimbursement and compliance with billing standards.
This article provides an overview of anesthesia time units, their calculation, and best practices for ensuring accuracy.
Define Anesthesia Time Units
Anesthesia time units are a key element in the billing process for anesthesia services. The Relative Value Guide, published by the American Society of Anesthesiologists (ASA), defines anesthesia time as “the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient, that is when the patient is safely placed under postoperative care.”
Time units represent the duration of anesthesia care provided to a patient, measured in increments that vary depending on the payer’s policies. Most payers define 1 unit as equivalent to 15 minutes of time, but some payers calculate units based on 10 minutes of time. It is important to be familiar with all your payer policies. Time units, combined with base units and any applicable modifiers, determine the total reimbursement for anesthesia services.
Know Components of Anesthesia Billing
The reimbursement for anesthesia services typically depends on the following factors:
The formula for calculating anesthesia reimbursement is:
Total Reimbursement = (Base Units + Time Units + Modifiers) × Conversion Factor
Calculate Anesthesia Time Units Like This
Time units are calculated based on the duration of anesthesia care, outlined in the Relative Value Guide definition above. Here’s how the calculation works:
For example, if a procedure lasts 60 minutes and the payer defines 1 unit as 15 minutes, the time unit calculation would be:
60 minutes ÷ 15 minutes/unit = 4 time units
Don’t Miss These Key Considerations
While there are formulas that apply to calculating time units, it’s important to be aware of some additional elements that can affect your results.
These elements include:
Beware Common Challenges and Incorporate These Best Practices
It’s important to keep an eye out for inconsistent documentation. Failure to document start and end times accurately can lead to claim denials or audits. This may also extend the time needed for the billing staff to submit the claim to the payer if a provider query to determine accurate time is necessary. Not having a clear picture of payer policies can also be problematic — misunderstanding payer-specific guidelines can result in incorrect billing. And, of course, check your numbers. Errors in rounding may lead to overbilling or underbilling.
There are some steps you can take to make sure your anesthesia time unit calculations are as accurate as possible:
Anesthesia time unit calculation is a critical component of the billing process that requires precision and attention to detail. By understanding the calculation method, following payer guidelines, and implementing best practices, healthcare providers can ensure accurate billing and avoid potential compliance issues. Proper documentation and regular training are key to maintaining the integrity of anesthesia billing practices.
Julie McDaniel, MHA, CPC, CANPC, Vice President of Operations at Rock Medical Practice Solutions