From a clinical perspective, addressing the operational needs of the perioperative suite internally may satisfy a hospital’s current needs. The problems that hospitals are discovering arise on the business side of anesthesia management, which is uniquely nuanced and challenging.
“Without a deep bench of industry-specific expertise, hospitals may be unaware that they are leaving millions of dollars on the table,” says Rhett Lankford, Senior Vice President and General Manager of the North American Partners in Anesthesia (NAPA) Managed Services Business Unit.
“For example, of all the medical specialties, only anesthesia requires specific coding that is generally unfamiliar to even experienced internal revenue cycle management (RCM) teams. Because every surgical procedure requires anesthesia, the accumulated financial impact of coding errors and related process deficiencies can be staggering. For a large hospital, increasing the collections yield by even 1% could add significant revenue to the bottom line, but to do so you need a team with a thorough understanding of anesthesia business processes, as well as sophisticated technologies that drive operational excellence and provide meaningful data with analytic insights.”
Managed services built for anesthesia
Lankford notes that to achieve key performance indicators (KPIs) in anesthesia RCM, hospitals need to succeed in each area of what he calls the “7 Pillars of Revenue Cycle.” These include:
- Front End Reconciliation and Registration
- Coding
- Billing and Claim Submission
- Clinical Documentation Improvement (CDI) and Revenue Optimization
- Accounts Receivable
- Payment Posting
- Patient Responsibility.
NAPA Managed Services supports each area with specialized teams, analysts, and proprietary technologies that facilitate a wide array of critical tasks, such as conducting real-time audits, enhancing cash flow by automating immediate reconciliation, identifying and remedying documentation flaws, and arbitrating out-of-network (OON) reimbursement outcomes (with a 98% success rate). Another critical focus is patient payments: After NAPA partnered with Cedar Pay to create a personalized, self-pay financial hub, one client achieved a 51% relative revenue lift while earning a 90% customer satisfaction score, and the platform continues to improve both collections and patient experience with stellar results.
Lynn Van Houten, NAPA’s Senior Vice President of RCM, says that overcoming the hurdles of anesthesia management often depends on having dedicated support from anesthesia-specific experts who understand the complexities of anesthesia billing, revenue optimization, and state and federal compliance.
Collecting millions in underpayments
Van Houten notes that an advanced, technology-driven platform is a necessity. She says, “Our singular industry expertise has enabled NAPA to partner with technology leaders such as AthenaHealth, Cedar Pay, and Fathom AI. Our clients benefit from the same robust technology that powers NAPA’s own RCM engine, and we consistently outperform our competitors by 2%.”
Explaining this process, she adds, “NAPA Managed Services leverages our anesthesia quality and billing experience with purpose-built, integrated tools to meet or exceed key performance indicators (KPIs). For example, at a large Southern health system, their internal RCM team did not realize how an insurer’s change to its billing guidelines generated a 50% deficit in eligible reimbursements, resulting in losses exceeding $6 million. NAPA Managed Services was the first to identify the problem, and we provided the data and partnership support the hospital needed to reverse the insurer’s decision and collect on current and retroactive reimbursements. In this case, our expertise helped our client ultimately collect more than $12 million in insurance underpayments. Furthermore, our RCM and billing systems have earned HITRUST Risk-based 2-Year (r2) Certification, which assures the highest level of cybersecurity.”
Solution for all anesthesia employment models
Lankford says that NAPA Managed Services was designed as a comprehensive solution for institutions that opt to maintain autonomy over their anesthesia services, allowing them to leverage NAPA’s experience in RCM, quality, data and analytics, talent recruiting, and change management.
“Performing the daily business of anesthesia includes critical functions such as Quality & Safety and compliance reporting, designing human resources strategies that support recruiting and retaining a right-sized anesthesia workforce,” adds Lankford. “In recent years NAPA has won two of the nation’s highest patient safety awards. We also maintain the industry’s highest clinical retention rate.”
He concludes, “NAPA has been the anesthesia single-specialty leader for nearly 40 years and remains at the forefront of the industry by anticipating and responding to our healthcare partners’ needs. Our vision for NAPA Managed Services is to support any employment model with a single source of anesthesia managed services, so that hospitals can focus on delivering clinical care to their patients without the burden of navigating the nuances and complexities of anesthesia.”
