Anesthesia conversion factors: where underpayments hide
Units only become dollars after someone multiplies by a conversion factor. Medicare publishes one (with geographic adjustment). Commercial contracts often publish another. If your biller never checks the CF, you will not see the leak. ClearBilling does. USA-based, woman-owned, anesthesia only.
Medicare
CMS publishes the national anesthesia conversion factor. Locality adjustments apply. It changes. A biller still using last year's factor is wrong even if every modifier is perfect.
Commercial
Contracts may specify an anesthesia CF, a percentage of Medicare, or a hybrid. Variance across payers in the same market is normal. Factories post whatever the EOB says as 'contractual' and move on. That is how 18% to 30% swings disappear into write-offs.
What to ask your current company
Show me expected vs allowed by payer for last quarter, using our contracted CFs. If they cannot, you do not have conversion-factor management. You have posting.
FAQ
Straight answers for practices comparing anesthesia billing companies.
Will you publish this year's Medicare CF here?
We will describe the mechanism. The dollar figure changes and is locality-specific. Use CMS and your MAC for the number that applies to a DOS. We apply the correct factor on claims we bill.
Is a higher CF always better?
A contracted CF is a contract. The failure mode is not 'get a bigger number,' it is 'get paid the number you already signed.'
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