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How is Anesthesia billed?

Anesthesia is billed by units using base + time.   Procedures are usually coded by a Certified Professional Coder and assigned a CPT code. CPT codes are assigned a base unit value by CMS (Centers for Medicare and Medicaid Services).   Those base units are added to the time units (usually 15-minute increments) and then that is multiplied by a conversion factor to get your billed amount.   There are sometime additional charges such as having pain blocks or for very young or very old, etc. Example: Let’s say you have to have your appendix removed and it takes 30 minutes and you are an otherwise healthy adult.   An appendectomy CPT code has a base unit value of 6 and 30 minutes is 2 time units. If you have a billed conversion factor of $100, your bill would be $800. How is Anesthesia paid by insurance? Anesthesia is one of those things you usually don’t get a choice in.   They are usually hospital based and the same group covers that hospi...
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Billing 101 for patients

Have you ever gotten a bill from the hospital or doctor and it doesn’t match your EOB from your insurance company?  Don’t always blame your doctor. There are a number of different reasons this can happen.  Bills are often sent to you automatically by a company’s billing software. Sometimes it is a true error. Sometimes it is because your provider is not in network with your insurance carrier.  Let’s do a little background on how the bills come to be from the billing side. Most billing companies use some sort of billing software.  Once they enter your information and insurance information (demographics) they will enter the charges and bill your insurance (file a claim). Some insurance companies pay very quickly, especially if the claim goes to them electronically.  Other insurance companies are slow at paying or don’t pay at all.  Most billing software has parameters are setup where if a claim isn’t paid within a certain amount of time they will rebelle...
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