Author Topic: Anesthesia billing  (Read 1989 times)

mojofla

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Anesthesia billing
« on: March 06, 2014, 04:11:37 PM »
My husband had a colonoscopy 12/2014.We received the anesthesia bill for the CRNA $995 and a bill for the anesthesiologist for another $995.Total bill for anesthesia services was $1990.The insurance paid $948 for the anesthesiologist and $167 for the CRNA.We were billed $726. I am a RN and I know the private self pay rate for anesthesia at our hospital is $500 first hour. The group is an independent group from the hospital.I asked one of our anesthesiologist about the bill and was given the answer well it probably was because we hadn't met our deductible.I questioned about the double billing for the service and how ridiculous the fee was for propofol anesthesia for no less a colonoscopy.Also questioned was why 2 providers were needed for a colonoscopy.Just got a shrug.Our insurance was billed at 100% for each provider.....but wait ...since when did you need 2 anesthesia providers to administer anesthesia for colonoscopies ? My husband called the anesthesia company and was told well that's the way they have always billed. A few years ago he had a bilateral inguinal hernia repair and I do recall billing for CRNA and the anesthesiologist.Both were paid $500 for each but the company at that time did not bill employees or family for difference.Since that time a different company bought out the anesthesia group.Same Dr's different owner.Is this a double billing practice? The colonoscopy itself was 100% covered.Seems like fraudulent billing practices
« Last Edit: March 06, 2014, 05:53:26 PM by mojofla »

Merry

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Re: Anesthesia billing
« Reply #1 on: March 06, 2014, 04:49:53 PM »
I have never heard of this. Why not contact the  http://www.asahq.org/ and talk to someone about the standard protocols for a colonoscopy. I have had major joint replacement surgeries and have only had 1 anesthesiologist. I cannot imagine having two, For what???? I would definitely question this by getting the info from American Society of Anesthesiologists. I would suggest you get names and dates of the call. Since you are an RN, they may speak to you differently as "you speak their language". Please let us know about this. I am very curious.

Merry

PMRNC

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Re: Anesthesia billing
« Reply #2 on: March 06, 2014, 05:54:29 PM »
Sounds like you had a cut for what's called "Usual and Customary". You need the operative report to appeal. If you gave us the exact remark codes on your EOB we can better help you. If this is a U/C cut, you can appeal it but you need the help of the surgeon to provide you with a letter and operative report. When U/C cuts happen the provider needs to show WHY the fee was higher than "usual and customary".  Yes the provider can bill you for the amount over if they were non participating with your insurance. Many times patient's have no control over "WHO" renders anesthesia, that is another reason for appeal. Again, I'm only GUESSING .. need the exact reason for the payment cut/denial.
Linda Walker
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Merry

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Re: Anesthesia billing
« Reply #3 on: March 06, 2014, 10:28:33 PM »
I think the issue is, why are there 2 anesthesiologists for a colonoscopy?
Am I incorrect?

PMRNC

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Re: Anesthesia billing
« Reply #4 on: March 07, 2014, 12:17:47 PM »
Quote
I think the issue is, why are there 2 anesthesiologists for a colonoscopy?

Hmm.. could that be? One though is being identified as CRNA .. They paid $948 so I'm thinking that's JUST on the Anesthesiologist? and they denied the $995 CRNA. ....

Quote
We received the anesthesia bill for the CRNA $995 and a bill for the anesthesiologist for another $995.Total bill for anesthesia services was $1990.The insurance paid $948 for the anesthesiologist and $167 for the CRNA.We were billed $726

Again, I think we need a better description of the denial to see WHAT was covered and what wasn't. Need the codes and denial reasons on the EOB to really take a better look at it.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Merry

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Re: Anesthesia billing
« Reply #5 on: March 07, 2014, 03:44:43 PM »
Not an MD bit have worked in the field of GI. I say double billing and that one if the anesthesia providers should not have been paid. Interesting how it passed edits.  And,  as you said,  this has been going on for a while.  Red flags for sure.  You are smart to catch this.  Most people would just pay without blinking.