Home Specialities Anesthesiology
Time-based billing
base + time units
Anesthesia-certified coders
anesthesia-record review
All major payers
commercial, Medicare & MA
Underpayment recovery
on claims marked paid
When revenue is measured in minutes, every rounding is a pay cut.
Ask an anesthesia group about revenue-cycle pain and you'll hear CRNA supervision, medical-direction compliance, and MAC audit risk. Real problems — the loud ones. Not the most expensive.
The most expensive one clears cleanly and posts as paid: a case whose time units were quietly rounded down, a modifier swapped, an add-on zeroed.
Across the 27 anesthesiology revenue cycles we've analyzed, an average of 4.1–7.4% of gross revenue is withheld this way. On a $15M group, that's $615K–$1.11M every year — and it compounds over every payer-contract cycle.
See what got rounded downWhat 4.1–7.4% looks like on a $15M group
The 4.1–7.4% range reflects OneMed's analysis of 27 anesthesiology revenue cycles. The dollar figures apply that range to a $15M example group. Your actual exposure depends on payer mix, case mix, modifiers, documentation, and time-unit accuracy.
Fifteen minutes of your work, worth one unit.
Time units are counted in 15-minute blocks. Miss the exact timestamps and payers round to the block below — and a single lost unit, multiplied by your case volume, is where the money goes.
| What the record shows | What it should bill | What the payer paid | The silent shortfall |
|---|---|---|---|
| 75 minutes, exact timestamps | 5 time units | 4 units (rounded to 60 min) | ~1 unit |
| MD directing 3 CRNAs (QK) | Directed rate | QZ applied → MD $0 | MD share |
| 85-year-old, controlled hypotension | 99100 + 99116 | Bundled → $0 | Add-on units |
| PACU nerve block for post-op pain | Billed separately | "Included in package" | Block value |
Illustrative of common anesthesia underpayment patterns; unit values, modifier applicability, and add-on eligibility depend on the record, contract, and payer policy.
Five ways time-based revenue gets quietly shaved.
Anesthesia billing is a precision game of units, modifiers, and concurrency rules. These are the underpayment patterns we find most often, on claims that already say "paid."
Time-based unit truncation
Anesthesia pays on (base units + time units) × your conversion factor, with time counted in 15-minute increments. When the record lacks exact start and stop times, payers round to the block below—a 75-minute case paid as 60, a 90-minute case paid as 75—quietly dropping a unit on case after case.
Medical-direction modifier misapplication
When a physician medically directs 2–4 concurrent cases, the claim bills with QK (physician) and QX (each CRNA). Payers swap in QZ (CRNA without direction) and zero the physician, apply QY when multiple CRNAs were directed, or pay the QK at 100% and deny the QX—inviting a clawback.
Qualifying-circumstances bundling
Extreme age, hypothermia, controlled hypotension, and similar circumstances carry add-on codes (99100–99140) for the added risk and complexity. Payers bundle them into the base case and pay $0 for the add-ons.
Concurrent-case overlap penalty
When a physician directs multiple CRNAs, brief clinically-appropriate overlaps happen—inducing one case while a CRNA maintains another. Payers flag the overlap and deny or halve the affected time without reviewing the clinical context.
Post-operative pain-management bundling
A PACU nerve block, epidural-catheter management, or complex pain titration by the anesthesiologist is separately billable, not part of the anesthetic. Payers bundle it as "included in the surgical package" and pay $0.
The unit is worth real money. Watch a 75-minute case pay for 60.
Anesthesia time is counted in 15-minute units: 75 documented minutes is 5 units, not 4. When the record lacks exact start and stop times, payers round to the block below — and you're paid for 60 minutes of a 75-minute case.
The formula is public and your conversion factor is in your contract; you can check the paid units against your own anesthesia records.
See it on your own claims75 minutes billed, 60 minutes paid
Time-unit counting (15-minute increments) is standard; the $25 conversion factor is illustrative — confirm your contracted conversion factor and each payer's rounding convention. Time-only figure; base units are additional.
Bandwidth, not effort
Your billing team isn't failing — they're buried in scheduling and CRNA credentialing while the back-end unit math goes unaudited.
The "paid means paid" blind spot
Your team chases $0 rejections; a claim marked paid closes the file — even if the payer quietly truncated a unit or swapped a modifier inside it.
No time-unit verification
Most groups never cross-check paid units against documented start and stop times — so a case billed at 5 units and paid at 4 is simply accepted.
No medical-direction ratio tracking
Without a system tracking directed vs personally performed cases, nobody confirms the QK/QX modifiers were right or that every linked line actually paid.
We reconcile every case back to the clock.
Seamless workflow integration plus anesthesia-certified coders. We work inside your existing systems — no EHR change, no disruption — and counter rigid payer rules with people who read the anesthesia record.
ClearView operational visibility
Our ClearView dashboard flags when a case paid below what its documented time units support, a medical-direction modifier was misapplied, or a qualifying circumstance was bundled — without changing how your staff logs in.
Expert clinical chart audit
Flagged claims route to our anesthesia-certified coders, who work inside your system to read the anesthesia record, verify the exact start and stop times, confirm the medical-direction ratio, and check the qualifying-circumstance documentation.
Targeted clinical appeal
We draft a documentation-backed appeal — the exact timestamps, ratio, or add-on documentation that supports the correct payment.
Payer pattern mapping
We track which payers truncate your units or bundle your qualifying circumstances, and pursue systematic corrections and contract fixes — not just one claim at a time.
The 2026 OneMed Anesthesiology Revenue Leak Index.
We don't rely on hypothetical math or isolated stories. We aggregated the anonymized data from every anesthesiology revenue cycle we audited over the last 18 months — here's the pattern it exposed.
27
anesthesia revenue cycles audited
118,000+
claims audited
$2.78M
recovered for clients
89.1%
recovery rate on appeals
Of that $2.78M, here's where it had been hiding. The truncated minute is the single biggest leak in anesthesia — because it repeats on every case.
| Underpayment pattern | Share of recovered value |
|---|---|
| Time-based unit truncation | 34% |
| Medical-direction modifier misapplication | 22% |
| Post-operative pain-management bundling | 19% |
| Concurrent-case overlap penalties | 15% |
| Qualifying-circumstances bundling | 10% |
Aggregated across OneMed anesthesiology underpayment audits over the trailing 18 months ($3.12M identified, $2.78M recovered). Individual results vary by payer, documentation, and contract terms.
Who We Serve?
Underpayment recovery and full-cycle billing for anesthesia.
Anesthesia care-team groups
Groups running the medical-direction model, most exposed to modifier misapplication and concurrency penalties.
Physician-only & solo anesthesiologists
Personally-performed practices where every truncated unit lands directly on the physician.
Hospital-based & ASC anesthesia
Groups covering facilities where time capture and record hand-offs create truncation risk.
CRNA & multi-site groups
Larger groups needing consistent unit auditing and payer-pattern mapping across providers and sites.
Your claims data, handled properly
A BAA is executed before any claims data is shared, and everything is handled in a controlled, auditable environment.
Keep the 90 days of PHI. Bring us 10 remits.
Moving 90 days of claims to a new vendor is a compliance hurdle. The lighter version: pull 10 recent anesthesia remits — medically directed, personally performed, and cases with qualifying circumstances — redact the identifiers, and we'll show the truncated units and misapplied modifiers live in 15 minutes, using your own data.
- 1 · Pull 10 EOBs — a mix of directed, personally performed, and qualifying-circumstance cases from your top payer.
- 2 · Redact identifiers — names, DOB, and member IDs come out; we work from codes, modifiers, units, and amounts.
- 3 · Send securely — the redacted remits go into our secure portal before the call.
- 4 · Live reveal — where units were truncated, a QK became a QZ, or qualifying circumstances were bundled.
Book your 15-minute teardown
We'll confirm a time within one business day.
Common questions.
How is anesthesia reimbursement calculated?
As (base units + time units) × a conversion factor. Time units are counted in 15-minute increments from documented anesthesia start and stop times — which is exactly why exact timestamps and clean records matter so much.
Which anesthesiology patterns do you audit for?
Time-unit truncation, medical-direction modifier misapplication (QK/QX/QZ/QY), qualifying-circumstances bundling (99100–99140), concurrent-case overlap penalties, and post-operative pain-management bundling, among others.
How do you find them?
Our ClearView dashboard flags cases where the paid units fall below what the documented time supports; then our anesthesia-certified coders read the anesthesia record and appeal with the timestamps and documentation that support the correct payment.
Do you make us change our EHR or workflow?
No. We work inside your existing practice-management and anesthesia systems and adapt to your workflow — no EHR change, no disruption.
What is the 10-claim blind teardown?
You pull 10 recent anesthesia remits, redact the patient identifiers, and we show the truncated units, misapplied modifiers, and bundled add-ons live in a 15-minute screen share — no bulk PHI upload, using your own data.
Do we have to switch billing companies?
No. The underpayment audit works alongside your current billing, and many groups start there before expanding.
Get paid for every minute you worked
Bring 10 remits to a blind teardown and see the truncated units, misapplied modifiers, and bundled add-ons hiding in them — in 15 minutes.