Avoiding Concurrencies in Anesthesia Billing: A Crucial Practice for Providers

In anesthesia billing, the term “concurrency” refers to the number of cases an anesthesia provider is involved in at the same time. Understanding and managing concurrency is essential for accurate billing and compliance with regulatory standards. This blog will delve into the concept of concurrency, its implications, and best practices for avoiding unintentional concurrencies in anesthesia billing.

Understanding Concurrency

Concurrency in anesthesia billing is a critical factor that influences how services are billed and reimbursed. It applies to all provider types, insurances, and anesthesia cases, though it does not extend to labor epidurals. The rules governing concurrency vary depending on the provider’s role and the supervision model in place.

For instance, a single anesthesiologist working alone can only be responsible for one case at a time. This ensures that the anesthesiologist is fully dedicated to a single patient’s care, providing the necessary attention and oversight required for safe anesthesia administration. Similarly, a Certified Registered Nurse Anesthetist (CRNA) working alone and unsupervised is also limited to one case at a time.

However, when an anesthesiologist is directing CRNAs and/or  Anesthesia Assistants (AAs), they can manage up to four concurrent cases. This model allows for efficient use of resources while maintaining high standards of patient care. Notably, there are exceptions to this rule: in South Carolina, an anesthesiologist can direct up to two concurrent AA cases, and in New Mexico, the limit is three concurrent AA cases.

Single Anesthesiologist provider working alone can only be responsible for one case at a timeA single CRNA provider working alone and unsupervised can be responsible for one case as a time
Anesthesiologist directing CRNAs and/or AAs can have up to 4 concurrent cases**Exception: South Carolina (2 concurrent AA cases) and New Mexico (3 concurrent AA cases)​

Best Practices for Avoiding Unintentional Concurrencies

Unintentional concurrency can lead to billing discrepancies, potential audits, and compliance issues. Therefore, it is crucial for anesthesia providers to adopt best practices to ensure accurate record-keeping and billing.

1. Review Records Thoroughly

Before closing or completing any patient record, providers should meticulously review all documentation. This includes verifying the correct start and stop times for anesthesia services. Accurate timekeeping is essential for determining concurrency and ensuring that each case is billed appropriately.

2. Document Hand-Offs Properly

Hand-offs between providers should be clearly documented. This includes noting the time of the hand-off and the names of the providers involved. Proper documentation ensures continuity of care and provides a clear record of who was responsible for the patient at any given time.

3. Utilize the 24-Hour Clock

To avoid confusion and errors in time documentation, it is advisable to use the 24-hour clock format. This eliminates ambiguities associated with AM and PM designations and ensures clarity in record-keeping.

4. Make Timely Amendments

If any discrepancies or errors are identified in the records, it is important to make appropriate amendments immediately. These amendments should follow the standardized protocols set by the Centers for Medicare & Medicaid Services (CMS) and Health Information Management (HIM) guidelines. Prompt and accurate amendments help maintain compliance and prevent issues during audits.

    Concurrency is a fundamental concept in anesthesia billing that requires careful attention and management. By understanding the rules governing concurrency and adopting best practices for record-keeping, anesthesia providers can ensure accurate billing and compliance with regulatory standards. Thorough record reviews, proper documentation of hand-offs, utilization of the 24-hour clock, and timely amendments are key strategies to avoid unintentional concurrencies and maintain the integrity of anesthesia billing practices.

    By implementing these best practices, anesthesia providers can focus on delivering high-quality patient care while ensuring their billing processes are accurate and compliant. For more detailed information on concurrency and anesthesia billing, please refer to the comprehensive guidelines provided by professional organizations and regulatory bodies or meet with one of our provider education experts.

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