Expert Anesthesiology Billing & RCM Services

Yes. We stay current on NSA regulations to ensure out-of-network billing, cost-sharing disclosures, and balance billing dispute resolutions are handled legally and efficiently. For anesthesia groups with mixed in-network and out-of-network participation, NSA compliance is an ongoing operational requirement we actively manage.

Most payers use 15-minute time units. Time begins at induction (or when the anesthesiologist begins preparing the patient for anesthesia) and ends when the patient is transferred to post-anesthesia care. The total time is divided by the payer’s time unit interval, then added to the base units from the ASA crosswalk code and any modifying units (physical status, qualifying circumstances) to produce the total unit count.

Medical direction applies when an anesthesiologist oversees two to four concurrent CRNA cases and documents seven specific activities for each case. Medical supervision applies to five or more concurrent cases — and reimburses at only three base units per case regardless of complexity. Most anesthesia groups aim to stay within the medical direction threshold to preserve full reimbursement. We monitor this daily.

In a medically directed case, the anesthesiologist bills with modifier QK and the CRNA bills with modifier QX — both on the same case, with the total reimbursement split. In a medically supervised case, only three base units are billable by the physician. When the anesthesiologist personally performs the entire case, modifier AA applies and full reimbursement is available. We apply the correct modifier set automatically based on the case documentation.