Why Anesthesia Billing Deserves More Attention — and How to Decide Between In-House or Outsourced
Authors:
Kelley Blair, CEO of nimble
Caryn Mattia, CPC, Sr. Director of Client Services at nimble
If you run an ASC, you already know how central anesthesia is to your daily operations. Nearly every case — 99% of procedures — requires it. And yet, when I talk with ASC leaders, anesthesia revenue is often the part of the cycle that gets the least attention.
I’ve heard it more than once: “When we signed our billing agreement, we were focused on the surgeons.” Or, “We’ve always had a vendor, but we still end up with denials and delays.”
It’s not surprising. Anesthesia billing feels complex, and if things seem to be “working well enough,” it’s easy to let it slide. But the reality is this: anesthesia revenue is too important to be an afterthought. And deciding whether to manage it in-house or outsource it deserves a clear financial look.
Why Anesthesia Billing Plays by Different Rules
Surgical billing is usually straightforward — a flat CPT code, billed and done. Anesthesia billing works on a different model. It’s based on units and time. That means every minute matters. Every modifier matters. Every payer’s unique rules matter.
If even one of those elements is off, collections suffer.
And unlike a single specialty, anesthesia touches nearly every service line — orthopedics, GI, bariatrics, cardiology, pain management, and more. If there’s sedation, there’s anesthesia. Which means for almost every case, there’s a second claim to manage accurately.
When a Proforma Can Help
That’s where a proforma comes in. Think of it as a decision-making blueprint. Instead of guessing whether your current approach is good enough, or worrying that outsourcing might be costly, you run the numbers.
A strong anesthesia proforma looks at:
- Case mix and volume – How often are anesthesia services required?
- Revenue capture – Are you billing every unit and modifier, or leaving money uncollected?
- In-house costs – Beyond salaries, what about software, compliance, and overhead?
- Payer contracts – Are anesthesia rates competitive? How are out-of-network claims handled?
When you put all that on paper, the choice between in-house and outsourcing usually becomes clearer — and less emotional.
Don’t Overlook Payer Contracts
Anesthesia revenue depends as much on contracts as it does on coding. Conversion factors can sit unchanged for years, modifiers like AA or QZ are applied differently by payers, and unclear language around medical direction versus supervision often drags down reimbursement. Some payers even push to bundle anesthesia into surgical contracts, though it should almost always be billed separately. And with out-of-network claims, too many groups write them off instead of negotiating.
These are the kinds of details that make a real difference in collections — and where having a partner with deep anesthesia expertise helps ensure nothing is left on the table.
Questions to Guide the Decision
If you’re weighing anesthesia billing options, start with a few simple but powerful questions:
- Do I know what anesthesia revenue really looks like in our center today?
- Are our contracts competitive, and are out-of-network claims handled well?
- Do we have the expertise to manage this internally, or would a specialized partner help us protect more revenue?
What Happens When You Get It Right
Consider one leading anesthesia group that was struggling with underperforming contracts, billing complexity, and an EHR that seemed to create more problems than it solved. They weren’t trying to add staff or expand volume — they simply needed billing handled more precisely.
Once they revisited their approach, the results spoke for themselves:
- 💰 8% increase in cash per case
- 📈 Collections reached new highs
- 📉 Accounts receivable days dropped to 30
-View their full success story here
The lesson? Improving anesthesia billing isn’t about doing more — it’s about doing it smarter.
The Bigger Picture
After years of working with ASCs, here’s what I’ve learned: anesthesia isn’t basic. It’s one of the most nuanced — and financially meaningful — parts of the revenue cycle.
When it’s managed well, you see the impact quickly: stronger collections, fewer denials, faster reimbursements. When it isn’t, the shortfalls may not show up immediately, but they add up over time.
That’s why starting with a proforma makes so much sense. It gives you clarity, confidence, and a roadmap — whether you keep anesthesia billing in-house or decide it’s time to outsource.
Want to see what this kind of analysis could reveal for your ASC? Sometimes putting the numbers on paper is the first step toward protecting revenue. Request a no-cost anesthesia RCM assessment.
