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How Medientsky Billing Helped an Underpaid Anesthesiology Practice Increase Cash Flow
Discover how our specialists resolved major billing issues for a Vermont anesthesiologist, doubling collections by correcting coding and enhancing claim processes.
Table of Contents
Introduction
The Backstory: A Practice Struggling With Low Collections
Jason was an anesthesiologist practicing in a relatively isolated area of Vermont. He had been using a small medical billing company in Rutland to manage his billing. However, he was increasingly dissatisfied with his collections. As he explained to Medientsky Billing:
“I’m not happy with my collections. It remains abysmal no matter how many hours I work.”
The challenge was not simply the amount of work involved in running the practice. Jason wanted to understand why the services he was providing were not generating the reimbursement he expected from various insurance companies and payers. Because of his location and limited access to modern conveniences, much of the communication and exchange of patient information with his existing billing service was handled manually. Patient demographics and other information were routinely couriered to the billing company or communicated by phone. Before accepting responsibility for the billing process, Medientsky Billing agreed to investigate the underlying revenue cycle issues.
Analysis of Jason's Revenue Cycle
Medientsky Billing reviewed the physical Explanation of Benefits (EOBs) that Jason had received from his billing company over the previous one-year period. The team also reviewed patient demographic information from the same period to identify patterns that could help explain the low reimbursements. During the analysis, Medientsky Billing identified a recurring pattern in the types of patients being treated. Many of the cases involved elderly patients with mild or severe systemic diseases. This prompted the experienced coding team to examine whether the physical status modifiers being used on the anesthesia claims were accurately reflecting the documented patient conditions. The review raised concerns that the existing billing service may have been using the wrong physical status modifiers in some cases.
Understanding the P2 and P3 Modifiers
According to the case study, Medientsky Billing identified the use of P3, which represents a patient with severe systemic disease, as an important factor in the practice’s reimbursement analysis. The team believed that the previous billing service may have been using P2, representing a patient with mild systemic disease, in situations where P3 could have been applicable based on the patient’s documented condition. The case study specifically points to conditions such as:
- Poorly controlled hypertension
- Morbid obesity
These types of cases can be more complex from an anesthesia perspective because of the systemic conditions and associated risks involved in treating the patient. The distinction between P2 and P3 therefore became an important part of the revenue cycle analysis. The Medientsky Billing team determined that the use of P3 was appropriate for a significant portion of the claims they reviewed and that incorrect modifier selection could have contributed to lower reimbursement. Rather than simply processing claims as they had been handled previously, the team examined the underlying coding and patient information to determine whether the claims accurately represented the services and patient conditions documented in the records.
From Revenue Cycle Analysis to Billing Support
A Billing Partner Who Understood the Practice
For Jason, the experience was about more than an increase in collections. He had been looking for a billing partner who could understand the specific requirements of his practice and identify why his existing billing process was not producing the results he expected. After reviewing his revenue cycle and addressing the coding issues identified during the analysis, Jason expressed his satisfaction with the new billing relationship.
Testimonial
“I think I’ve finally found the right biller”
Jason further described his experience:
“Running from pillar to post looking for a biller who understood my needs, I’ve finally found the best solution. It shocked me that I was being repeatedly underpaid all these years. I’m really happy with your services.”
The testimonial reflects the central issue identified in the case study: the practice needed a billing partner capable of looking beyond routine claim submission and examining the reasons behind its reimbursement performance.
Actionable Financial Data in a Few Taps
Medientsky Billing also introduced Jason to its real-time financial KPI reporting app. The app provided analytical reports that helped Jason track his claims cycle and monitor important revenue cycle information. The reporting included detailed information related to:
- Collection KPIs
- Charge capture KPIs
- Claims cycle performance
- Revenue cycle activity
Having access to this information gave Jason greater visibility into the financial performance of his practice. Instead of relying solely on the results of individual claims or periodic billing updates, the reporting system provided a way to review key revenue cycle indicators and better understand the practice’s financial performance.
Why Anesthesia Coding Accuracy Matters
The Importance of Revenue Cycle Analysis
Low collections do not always indicate that a practice lacks patients, performs too few procedures, or needs to increase its workload. Sometimes, the underlying issue can be found within the revenue cycle itself. Jason’s experience demonstrates the value of examining:
- Existing EOBs
- Patient demographics
- Coding patterns
- Physical status modifiers
- Claim processing
- Collection performance
- Charge capture data
A detailed review of these areas can help identify patterns that may otherwise remain hidden within routine billing operations. For this anesthesiology practice, the analysis uncovered a potential coding issue that helped explain why reimbursement had remained below expectations.
Results
The partnership between Jason and Medientsky Billing resulted in a clear improvement in the practice’s financial performance.
Average Earnings Doubled
The most significant result reported in the case study was that Jason’s average earnings doubled after working with Medientsky Billing.
Coding and Claim Processes Reviewed
The revenue cycle analysis identified concerns related to physical status modifier usage and helped address the way claims were being coded and processed.
Greater Financial Visibility
Through the real-time financial KPI reporting app, Jason was able to access analytical information related to collection and charge capture performance.
A More Suitable Billing Partnership
Beyond the financial improvement, Jason found a billing partner that he felt understood his practice’s specific needs and the complexities associated with anesthesia billing.
Conclusion
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Highlights
- 15% No Usage of AI and Automation Technology
- 87% Patient-Provider Communication
- 40% Reduction in Claim Denials
Client Specs
- Location: Washington
- Specialty: Behavioral Health
- EHR: Incredible
- Average collections: 300K per month
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