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reimbursement

  1. #1
    Default reimbursement
    Medical Coding Books
    I have a question concerning reimbursement rates for anesthesia. Is anyone getting more than about 10% from medicare? One of our claims went out at $1700 and came back from medicare with $150 reimbursement. Does this sound right to everyone? We are finding this across the board for medicare and about twice as much from commercials. We just want to make sure we're in the right ball park and not doing something way wrong. We're in Indiana and our rate is $20 something a unit. Can't remember right off the top of my head. Last year was $19.08 a unit. any and all comments appreciated and helpful! Thanks

  2. #2
    Default
    Anna,

    As you know it would depend on the total units submitted but yes - $150 does sound low. I show that the Indiana Medicare conversion factor is $20.16 per unit so that means that Medicare only paid approximately 7.4 units on your claim and I'm guessing, at a $1700 charge, your claim was for substantially more units. If you can, I would review the EOMB to make sure they correctly captured the anesthesia minutes.

    Send me a private message with your phone number if you would like to discuss exact claim detail.

    Julie, CPC

  3. #3
    Default reimbursement
    Quote Originally Posted by jdrueppel View Post
    Anna,

    As you know it would depend on the total units submitted but yes - $150 does sound low. I show that the Indiana Medicare conversion factor is $20.16 per unit so that means that Medicare only paid approximately 7.4 units on your claim and I'm guessing, at a $1700 charge, your claim was for substantially more units. If you can, I would review the EOMB to make sure they correctly captured the anesthesia minutes.

    Send me a private message with your phone number if you would like to discuss exact claim detail.

    Julie, CPC
    Julie, Thanks, we are going to pull a couple EOMB and see what's up. Maybe your correct, we haven't really checked that out. I may indeed PM once I get a look at the EOMB. Thanks for your time.
    Anna, CPC

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