Increasing Revenue at Your Anesthesiology Practice Utilizing a Charge-Hold Strategy

 In Medical Billing & Claims, Revenue Cycle

Should you consider a charge-hold strategy for your anesthesiology practice? Ten to fifteen years ago, this strategy would have been considered absurd.

As we all know, co-pays and deductibles have increased tremendously in recent years and that trend will likely continue.

Currently 85% of covered workers have a deductible in their plan, up from 81% in 2018 and 59% a decade ago. The average single deductible now stands at $1,573 for those workers who have one, similar to last year’s $1,505 average but up sharply from $735 in 2008. These two trends result in a 212% increase in the burden of deductibles across all covered workers.[1]

In order to maximize revenue, many anesthesia practices that we have seen employ a charge-hold strategy by purposely holding their charges from seven to 40 days. The strategy is simple: the insurance company absorbs the deductible because the facility charges are processed by the insurer first and then the anesthesia charge gets processed after the deductible is met. See this example image of how this would work:

Charge Capture Example

How does a charge hold work?

The process is simple: all charges that were immediately entered into a vendor’s system are checked for missing information (diagnosis, anesthesia type, etc.), medical direction requirements are validated, and then the system releases certain payers, and others are held based on the hold strategy. Meaning that each day, the vendor’s billing system releases another day of charges for specific payers. Some vendors even employ technologies that electronically verify patient insurance eligibility, and a reporting system whereby the effectiveness of the strategy is measured and adjusted on a regular basis.

How long should you hold your group’s charges?

The answer is, it depends.
You should look at the individual payers and consult an experienced anesthesia business manager and collectively decide what charge hold makes sense for your practice. You could also consult an anesthesia billing consultant who will provide you with advice on what payers to place on hold, and also help you develop custom reports to evaluate the effectiveness of the holds for those specific payers.

Based on my experience, there is no reason to hold any government payers (Medicare, Medicaid, and Workers Compensation) because these patients have a very low co-pay and deductible or no patient responsibility whatsoever. More recently, I’ve seen over twenty groups employ this strategy and the most effective holding period is 21 days from the date of service. From my personal analysis as a practice manager, there was a significant payment improvement from a 14 to 21 day hold, and virtually no change in effectiveness from day 21 to day 40.

What additional revenue can your practice expect from this strategy?

The reimbursement varies from group to group, but typically if a group holds charges for 21 days, by the end of the 12th month the increase in revenue typically equates from 1% to 3% of collections. Assuming these commercial payers pay your group $5 million per year, an additional 1% to 3% will generate an additional $50,000 to $150,000 each year. This is what I have typically seen as a practice manager and through my experience here with our customers.

I have also witnessed a positive by-product of this strategy. Since the insurance company is paying the majority of the patient’s claims, fewer charges are being sent to the collection agency and therefore, there are fewer patient complaints. So your group is collecting the payments for the cost of the billing fee (i.e. 4.5%), compared to 30%-40% charged by most collection agencies (again, what I have typically seen as a practice manager).

What are the results of a charge-hold strategy?

Here is one example:

  • The group’s commercial patients paid 10.45% of their anesthesia bill when claims were released immediately
  • The following year, the hold strategy was employed. Patients paid 7.18% of their anesthesia bills when claims were held 21 days.
  • Bad debt went from 3.39% to 1.78% for commercial payers, with a positive financial impact of approximately $88,000 to the group.
Charge Hold Example


You now have seen that there are many opportunities to grow and maintain your client business just by carefully monitoring and being ready to react to financial report trends. Being constantly aware of both the challenges and opportunities is critical to the success of your business.

There are many strategies to increase revenue at your anesthesiology practice, but a charge-hold strategy is one to consider, especially with a trusted vendor partner who can help lead the way with extensive payer relations and robust reporting.

To learn more, call 866-817-3813 or visit:

1. Source: Kaiser Family Foundation, 2019:

In my more than 20 years in anesthesia billing and practice management, I have seen that business is getting tougher for the providers. They are working more hours, taking more calls, financially dealing with a worsening payer mix … all of which results in pressure.

I have been asked multiple times by ...

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