“A rigid, one-size-fits-all approach usually ends up fitting no one.”
— Patrick Lencioni, The Advantage: Why Organizational Health Trumps Everything Else in Business
Business consultant Patrick Lencioni expressed it well when he noted the limitations of a one-size-fits-all approach to organizational health. In our extensive experience with medical practice financial health, this observation most certainly applies to the complex discipline of Anesthesia revenue cycle management (RCM).
Whether small or large, Anesthesia practices face a unique set of challenges depending on their underlying characteristics. Small physician-run businesses may lack administrative support for basic billing and coding. They need entirely different RCM services than a large regional or national practice looking to optimize collections and streamline billing processes. No single, off-the-shelf RCM strategy will successfully address the needs of all types of practices.
To further complicate the equation, Anesthesia practices don’t necessarily follow a predictable growth trajectory – nor may a practice be interested in growing intentionally. Over time, numerous factors can influence Anesthesia caseloads, including hospital contracts, staffing shortages, patient-volume fluctuations like we saw during the Covid-19 pandemic, and more. The key to success in Anesthesia RCM, therefore, is two-fold: Practices must find RCM resources customized for their current business model, and those resources must be able to flex and scale with them as their business needs evolve.
Small But Mighty Practices: Create a Strong Foundation
Small practices with up to 30 providers will be focused on solving their basic billing and management needs. Often, the providers themselves are splitting duties and taking on the administrative work of running a practice, which can quickly become unsustainable if significant growth occurs.
From an Anesthesia RCM perspective, outsourced billing and coding services make a lot of sense at this stage. It is critical to engage an RCM partner who not only delivers basic services but can help the practice thrive.
Important Sample Resources:
- Anesthesia-Specific Billing Expertise
Small practices need just as strong of an RCM partner as larger, more complex practices. Anesthesia RCM requires specialized knowledge of time-based payments, payment modifiers, coding requirements for physicians versus CRNAs, billing for anesthesia blocks, and more. RCM teams also need purpose-built software that is designed with the correct workflow configurations to execute and analyze these types of charges. - Metrics that Matter
While there are hundreds of specific metrics that practices can track and measure, we find that five key metrics paint a thorough and accurate picture of financial health. Small practices need to rely on their RCM providers to set up baseline analytics, tracking and reporting on metrics such as net collection rate (NCR), cash per unit (CPU), and days in accounts receivable (AR). They also need to help practice leaders understand the results and use them to implement changes that will improve revenue. - Contract Negotiation
Reimbursement begins with the contract. Payer strategy and negotiation are essential for small practices to help reevaluate contracts on a regular basis. Additionally, negotiated hospital stipends are uniquely critical for Anesthesia providers, who rely on their facilities to help make up a shortfall caused by continually eroding CMS rates. All practices—but small practices in particular—need a strong partner at the table who can provide benchmarking data to support reasonable rate negotiation, as well as leverage payer and facility relationships to arrive at equitable results.
Mid-Sized Practices: Scaling Operations
Mid-sized practices with up to 100 providers need support to scale. With basic administrative functions likely already in place, they are ready to optimize processes to maximize reimbursement, building revenue to support a growing staff of physicians, CRNAs, AAs, and administrators.
Practices in this category need an Anesthesia RCM partner who can examine every aspect of the revenue cycle searching for opportunities to improve.
Important Sample Resources:
- Advanced Data & Analytics
With key metric tracking in place, mid-sized practices are best served by delving deeper into the nuances of their revenue cycle health. Custom reporting can illuminate specific revenue challenges—monthly cash flow, for example, or Anesthesia payments by individual payer or by payer category. Practice leaders should expect 24/7 access to their data through interactive dashboards, but they also need hands-on, proactive counsel to help them make the most of the results. - Denials Management
Sixty percent of medical groups say they had more denied claims last year than they did the year before, according to a Medical Group Management Association Stat poll. As such, denials are a big-ticket target area for meaningful revenue improvement. RCM partners can leverage machine learning and automated alerts to flag upticks in denials, root out the sources (changes in payer policies, for example, or coding errors), and help ensure claims go out clean. On the back end, an RCM partner who can navigate and withstand the appeals process will pay dividends (quite literally) as more than half of denials are ultimately approved—a figure that analysts say could be even higher if more providers had the resources to pursue appeals. - Provider Education
Practice leaders often underestimate the correlation between accurate provider documentation and appropriate billing and coding. In fact, incomplete clinical documentation is a huge revenue risk, leading to missed billable services, down-codes and underpayments, denials, and time-consuming payer audits. Expert coders are providers’ best resources to learn what payers need to see in order to support reimbursement at appropriate levels. With ongoing documentation feedback and focused provider training, mid-sized practices can recover significant revenue by improving documentation.
Large Groups & Practices: Optimizing Existing Revenue
Large Anesthesia groups—big regional, national, or hospital-owned practices with >100 providers —need RCM support that meets them wherever they are. With expansive systems already in place, an off-the-shelf RCM approach will be highly frustrating and potentially counterproductive in places that are already working well.
Instead, large Anesthesia groups need bespoke solutions that optimize revenue in targeted ways designed to have the most impact.
Important Sample Resources:
- Customized Data & Analytics
Large-practice leaders should dig deep into their data. Granular reporting on expected reimbursement, cases by surgical specialty, and year-to-date comparisons to the prior year can help forecast for budgeting and hiring purposes. Custom reporting can be configured in countless ways and leveraged to reduce aged accounts, increase payments from a specific payer, target frequently down-coded services for improvement, and much more. - Advisory Services
High-level consultants can help guide large practices through complex operational issues, compensation challenges, and contract negotiations. Services available to practices at this stage include compensation benchmarking, utilization and efficiency reviews, coding reviews, accreditation and regulatory support, recoupment defense, transition management, RFP process management/implementation, and more.
How Ventra Can Help
Ventra Health’s white-glove approach was designed to deliver a customizable service experience for all Anesthesia practice models.
Built on more than 40 years of experience maximizing revenue for Anesthesia and other facility-based physician specialties, our core billing and coding services provide a strong foundation for all practices. Our teams leverage Ventra’s proprietary, purpose-built Anesthesia billing software platform, as well as their own deep expertise in the complex regulatory and compliance landscape.
Billing and coding are table stakes, however. Ventra can scale to address the needs of growing practices with extensive consultative services, including expert contract and subsidy negotiation, provider education, custom strategic planning, and detailed auditing and benchmarking. Further, all our clients have the benefit of vSight™, our powerful data & analytics platform, which offers real-time performance metrics and actionable insights our teams use to improve claim processing, reduce denials, and maximize revenue.
In Anesthesia practice RCM, a one-size-fits-all approach does, indeed, fit no one. Instead, look for customizable RCM support that responds to the evolving needs of your practice.
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