Anesthesia Concurrency Billing

Anesthesia Concurrency Billing in NextGen® Enterprise PM can be setup and used by practices that must meet specific requirements on professional claims for anesthesia services that occur at the same time, or concurrently.

Concurrency billing is typically used when the practice submits 837P/1500 claims for numerous anesthesia procedures that are administered in a hospital surgery department setting by Anesthesiologists and medically directed Certified Registered Nurse Anesthetists (CRNA).

An Anesthesiologist can personally administer anesthesia to a patient. They can also oversee the administration of anesthesia by Certified Registered Nurse Anesthetists (CRNA) and Anesthesiologist Assistants (AA). When an anesthesiologist oversees up to four concurrent cases, it is considered "medical direction".

In NextGen® Enterprise PM, an Anesthesia Concurrency Audit process is run prior to billing and creating claims. The audit looks at encounters with charges that were rendered by anesthesia providers on the same date and reviews the start and stop times on those charges to identify time overlaps and instances of concurrency between encounters that may affect billing. After passing the audit, payer-specific rules defined in the Anesthesia library are applied to each encounter. For example, modifiers may be added to charges based on the level of medical direction, anesthesia time units and charge amounts may be adjusted for specific SIM codes, and charges may split between the Anesthesiologist and CRNA resulting in a separate claim for each.