Changes Coming to Anesthesia Billing Guidelines

Anesthesia billing guidelines are always changing to make the whole system better for all physicians, health care professionals, payers and clearinghouses. Everyone involved will be required to process claims under the new 5010 electronic transaction standard by January 1, 2012.

The updated version of the transactions will have data reporting requirements that are different from the current ones.

Two changes in the billing guidelines

1. In the 4010A1 version of the professional claim transaction, anesthesia services may be reported in actual minutes or in units of time. In the 5010 version, only actual minutes may be reported.
2. This change involves the reporting of the billing provider address. In 5010, the address can no longer be a PO Box or lock-box address.

Benefits of the new 5010 change in anesthesia billing guidelines

– The 4010 was introduced in 2000. Since this time, the ASC X12 Committee has been working to identifying technical issues, accommodating new business needs and removing inconsistencies in the standard.
– The 5010 is intended to implement these improvements, to reduce the number of ambiguities in the implementation guides and to remove unused content from the 4010 format.
– Of particular importantance are the modifications required by the 5010 that are a prerequisite to the move from ICD-9 to ICD-10 coding, since anesthesiologist billing codes will increase in 2013.

Start making changes now

It is recommended that all anesthesia practices and anesthesia management companies make changes to their billing guidelines and systems now. You’ll need to be ready in before the compliance deadline to avoid transaction rejections and subsequent payment delays.

The American Medical Association provided several steps that your practice or anesthesia management company can take.

Step one is to become familiar with the upgrade and conduct an internal impact analysis to determine the impact the change to 5010 will have on your business practices and systems.

Step two is contact your vendors, payers, billing service, and clearinghouse.

Step three is to undergo installation of upgrades from your vendor.

Step four is to conduct internal testing of your systems to ensure you can generate the 5010 transactions.

Step five is to contact your clearinghouses, billing service, and payers to conduct external testing with them.

Step six is to make the switch to 5010. You are permitted to begin using the 5010 transactions prior to the compliance date, as long as you and the other organization are in agreement with the early conversion.

After January 1, 2012, you should monitor the submission and receipt of 5010 transactions to ensure they are working properly. Deadlines for some changes are pushed back but don’t expect there to be a delay in the compliance deadline. The Centers for Medicare & Medicaid Services (CMS) has made it clear that there will be no extension of the deadline for 5010.
Now that you know changes are coming to anesthesia billing guidelines make sure your practice and/or your management company start preparing now.

Contact us today and let us keep tabs on the anesthesia billing guidelines for you so you.