How the CMS surprise-billing law will impact anesthesia reimbursement

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For anesthesia practices that submit a significant number of out-of-network claims, the new No Surprises Act could mean less revenue. 

Tony Mira, founder of Anesthesia Business Consultants, discussed how anesthesia practices will be affected by the new law in a July 7 blog post.

The proposed final rule mandates that cost-sharing, such as coinsurance and deductibles, be based on in-network provider rates. Surprise billing for ancillary services at in-network facilities would be prohibited, including for anesthesia services.

In terms of existing out-of-network volume, Mr. Mira expects impact will be low. In an analysis of client data, he found that 8.9 percent of the insurance codes in the analysis were from a nonparticipating provider, and only 1.1 percent of claims in 2020 were for noncontracted care. 

But for practices that do make out-of-network claims, Mr. Mira expects reimbursement to decline when the provisions take effect in January 2022. 

Read his full analysis here


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