Billing question

[Mister Mxyzptlk]

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It's been a long time since I billed for anesthesia. Maybe things have changed a lot so I'm posting here for clarification.

I have had two patients complain that they received two anesthesia bills after their procedures. It appears that there is one bill for the MD and another for an equal amount for the CRNA. After insurance pays their part the patients are being hit for the remainder. These are not small bills. They are billing $750 apiece for a 10-minute pain procedure.

My nurse had her tonsils removed. Her ENT bill was $300 and she was walloped with two bills totaling $1250 by the same anesthesia group.

 

[jwk]

It's been a long time since I billed for anesthesia. Maybe things have changed a lot so I'm posting here for clarification.

I have had two patients complain that they received two anesthesia bills after their procedures. It appears that there is one bill for the MD and another for an equal amount for the CRNA. After insurance pays their part the patients are being hit for the remainder. These are not small bills. They are billing $750 apiece for a 10-minute pain procedure.

My nurse had her tonsils removed. Her ENT bill was $300 and she was walloped with two bills totaling $1250 by the same anesthesia group.

There are a ton of factors that go into medical billing, including anesthesia.

Many groups have their anesthetists assign their billing rights to the group, so a patient only gets one bill. If the anesthetist works for the hospital and the anesthesiologist is solo or with a group, then the patient will have separate professional fees.

I assume you know there is a big difference between what is billed and what insurance companies pay. Is that $300 the net the patient owes the ENT out of pocket, or the amount billed, or the amount insurance actually paid in-network? I would be willing to bet that a non-discounted professional fee for a tonsillectomy is far in excess of $300. Maybe she got a write-off or discount for professional courtesy (an ever decreasing perk and questionable practice anyway).

On the other hand, that $1250 for anesthesia (or $750 apiece or whatever) may represent a non-discounted fee before insurance comes into play. A tonsillectomy at Medicare rates in our area probably would bill out at less than $200 total, and many insurance companies are paying ridiculously close to Medicare rates. $1250 does sound high though. I don't know the RVU for a tonsil, but lets guess 7 units, and 5 units for time, for a total of 12. Even at a very high $75/unit, that would only be $900. Without knowing specifically who billed what, it's hard to tell.

 

[Idiopathic]

is this an example of where when you have two anesthesia providers present you can bill for both the procedure and the sedation in pain procedures? i have no experience in this but have heard about this as a 'perk' of the special.ty