Anesthesia Medical Billing & Credentialing Services

Anesthesia Billing Challenges

Anesthesia claims are unique. They require a deep understanding of:

• Time-Based Billing Units: Reimbursement is calculated using base units + time units + modifying units.

• Start and Stop Time Tracking: Payers require exact documentation (e.g., anesthesia started at 08:12 and ended at 09:24).

• Physical Status Modifiers (P1–P6): These indicate patient condition and affect payment. Using the wrong modifier can trigger audits.

• Concurrency Rules: When multiple cases are overseen simultaneously, concurrency must be calculated and billed correctly (especially for CRNAs).

• Anesthesia Modifiers: Modifier usage is critical:

  • AA – Anesthesia services performed personally by anesthesiologist

  • QK – Medical direction of 2-4 concurrent procedures

  • QX – CRNA with medical direction by physician

  • QZ – CRNA services without medical direction

• Medical Direction Requirements: Documentation must meet all seven steps of CMS medical direction (pre-anesthetic eval, induction, post-anesthesia care, etc.)

Common Anesthesia ASA Codes & Base Unites

Credentialing for
Anesthesiologists & CRNAs

Credentialing anesthesiology providers involves multiple layers:

• State license verification

• Hospital privileges

• DEA registration

• Board certification validation (ABA, NBCRNA)

• Payer-specific documentation (medical direction compliance)

We credential:

• Solo anesthesiologists

• CRNAs (employed or independent)

• Anesthesia group practices

• Pain management specialists offering sedation

Facility Types We Support

Oakview provides anesthesia billing across various care settings:

• Inpatient hospitals

• Ambulatory Surgical Centers (ASCs)

• OB/GYN practices

• Outpatient procedure centers

• Dental anesthesia clinics

• Orthopedic & pain management facilities

Insurance Plans & Compliance

We credential and bill anesthesia services for:

• Medicare & Medicaid

• Tricare / ChampVA / VA

• Commercial plans like Aetna, UHC, BCBS, Cigna, Humana

• Managed Care Plans

• Anesthesia carve-outs (e.g., in-network only for facility)

We ensure:
✔ Concurrency logs are clean
✔ Modifiers match documentation
✔ No double billing for CRNA & supervising MD
✔ Compliance with CMS 7 Steps Rule
✔ Faster TAT on prior auths (MAC anesthesia)

Oakview’s Anesthesia RCM Highlights

• Daily tracking of start/stop times & anesthesia logs

• Custom encounter forms (paper or digital)

• Real-time claims status monitoring

• Advanced denial analytics for MAC, CRNA, and surgical bundles

• Appeal management for time disputes & medical necessity