How many billable units per year

yoga crna · Aug 1, 2005

A better question is--what percentage of billing do you collect?

It all depends on the practice setting, the type of cases, the reimbursement model, and contractual arrangements. For example, I receive 100% my cosmetic surgery cases, based on a set fee schedule (no units). I receive less than 10% payment on my Medicaid cases (on an already reduced basis of about $11/unit).

The business and economics of health care and anesthesia are interesting topics that need to be addressed in our education.

Yoga

William_SRNA · Aug 2, 2005

Yoga,

I ws thinking about 10% as non-payers (relative to where you work) I was figuring about on average collecting about $13 per billable unit as a mean but not sure if that is asking too much. That's what I am looking at is what the average pay was per billable unit and what the average amount of billable units generated per CRNA.

Thanks

yoga crna · Aug 2, 2005

Wow,

You are way off base on fees. While we will never know the average unit charge for anesthesia, I would guess that it is about $65+ per unit. Medicare sets its own rate, based on geography, that averages about $18.50 a unit.

Billable units are usually time and procedure (relative value) oriented and there are many modifications of them. For example, Medicare doesn't pay additional units (modifiers) for things such as emergencies and high risk patients. Whereas, private insurers usually pay.

This forum appears to be mostly for those wanting to be CRNAs. I would suggest you go to [email protected] for good discussion of business issues.

Good luck on your quest for information.

Yoga

William_SRNA · Aug 2, 2005

How much of your practice do you get full payers and does most insurace follow the medicare guidlines as far as reimbursement? Our instructor was expalining that 5 crnas could generate 1,000,000 billable units per year in a group setting but that seems high to me, with what CRNA salaries are today. Now I know half of that would be expenses or maybe even more but that would still leave over 1 million per CRNA.

yoga crna · Aug 3, 2005

You are asking good questions and I am pleased that students are interested in this topic.

The answers to your question are not simple, but I will try. First of all, consider the average case is 10 units, multiply that by $50/unit. That will give you some idea of averages. My practice is different because my insurance cases are mainly cataracts, with a large number being Medicare. Also, I only do those one day a week, with the remainder of my practice being cash (cosmetic surgery) cases.

If you can get a copy of the ASA Relative Value Guide you will see the base unit value of cases, then add time units and multiply by a conversion factor for the professional anesthesia portion of a patient's bill. Also, not all of your time is billable units. Insurance does not pay when you are not administering anesthesia. So, if you are taking call, that is not billable time.

Depending on your geographic area and who pays for health care, insurance may pay full price to almost nothing. I find that union contracts and government workers generally have good insurance. But, if you work in an intercity hospital with lots of indigent patients, you may do a lot of free anesthesia.

I consider anesthesia a low overhead business. My primary expense is malpractice insurance. Other expenses include my own health insurance, automobile expenses, computer, phones, taxes, pension plan, billing service, accountant and of course, my salary.

Hope that helps.

Yoga