How an Anesthesia Group Increased Collections by 38%
Strategic IDR filing for high-volume practices
Regional Anesthesia Group
Regional Anesthesia Group
About
A 45-physician anesthesia group providing services across 12 surgical centers and hospitals in the Southeast.
Industry
Anesthesiology
Company size
50-75 employees
Headquarters
Atlanta, GA
Founded
2012
Annual Claims
$28M+ billed annually
Key Features Used
Challenge
With high claim volumes and complex payer contracts, the group was experiencing 23% average underpayment on out-of-network cases. Manual appeals were consuming 60+ hours per week with inconsistent results.
Solution
Implement Clearest to systematically identify underpaid claims, prioritize by expected value, and file IDR disputes with specialty-specific benchmark data for anesthesia services.
Illustrative Results
$1.8M recovered
Additional revenue in first 9 months
38% increase
In average reimbursement per case
91% win rate
On disputes with benchmark evidence
60 hrs/week saved
Appeals time eliminated
The anesthesia reimbursement challenge
Anesthesia billing is uniquely complex. Time-based units, modifier stacking, and facility-specific requirements create endless opportunities for payer underpayment.
The anesthesia group had built a strong clinical reputation, but their revenue cycle was leaving money on the table. Out-of-network cases were being paid at rates 40-60% below what peer groups received.
The billing team tried to keep up with appeals, but with 3,000+ claims per month, they could only dispute a fraction of underpayments.
Illustrative perspective
We knew we were being underpaid, but we had no way to prove what fair payment should look like. Clearest gave us that proof.
Data-driven case selection
Clearest analyzed the group's claims data and identified patterns of systematic underpayment by specific payers and CPT codes. Certain high-acuity cases were being paid at base rates regardless of complexity.
The platform prioritized 428 disputes representing the highest expected recovery. Each case was scored based on the gap between payment received and peer benchmark data.
Specialty-specific evidence
Anesthesia cases require specialized benchmark data. Clearest provided comparisons specifically for anesthesia services, accounting for time units, case complexity, and geographic factors.
The dispute packets demonstrated clear evidence of underpayment relative to what similar anesthesia groups receive for identical services.
Illustrative perspective
The benchmark data was exactly what arbitrators needed to see. It made our cases undeniable.
Sustainable revenue improvement
The 38% increase in average reimbursement translated to predictable monthly recoveries. The group now has visibility into their entire claims portfolio and can project revenue with confidence.
The freed-up billing staff now focus on front-end processes, reducing denials and improving first-pass resolution rates.
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