Anesthesia Industry eAlerts
Sent to subscribers every Monday morning, our eAlerts deliver timely updates on regulatory, legislative and practice management developments of interest to anesthesia professionals.
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eAlerts
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The Future of Acute Pain Payment in Anesthesia
October 26, 2020
A review of the history of payment for medical services in the United States reveals a frustrating reality: every time a new service becomes a standard of care, payment is eventually reduced or eliminated. This was true of payment for fluoroscopy in chronic pain where, over the past five years, fluoroscopy has been bundled into the payment for most nerve blocks. We have seen a dramatic growth in the role of anesthesia for endoscopic procedures, the result of which has been new anesthesia codes for endoscopic procedures and a reduction of the base value for lower G.I. procedures. These are just two examples, but the principle can be observed in almost every specialty. It is the law of supply and demand being applied to medicine. As the supply of a particular procedure or service increases, the payment will inevitably drop.
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The Clinical Classroom: Anesthesia in the Teaching Environment
October 19, 2020
The requirements for participation and billing in the teaching setting are somewhat complex and often misunderstood. Many are uncertain about what they are allowed to do and to bill. In this two-part series, we hope to provide greater compliance insight to those working with residents and student nurses.
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Anesthesia for Endoscopic Procedures: An Update
October 12, 2020
No one aspect of anesthesia care has been the subject of such practice focus and policy updates as endoscopy. The story of endoscopic anesthesia care can be written in three chapters with a possible epilog called COVID-19. While for many ABC clients this has been the fastest growing and most profitable line of business, the good train endo seems to be encountering some headwinds, and it is not entirely clear what the future holds. Most client surgical venues have seen case volumes return to pre-COVID-19 levels, with the exception of those dedicated to endo cases. It is true that some client practices have seen their endo volumes return to normal, but these are the exception rather than the rule. It is a complex story with many dimensions including, health care policy, economics and practice management. Every time we think the last chapter has been written there is a new factor to be taken into consideration.
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Heading to the Office: A Closer Look at Office-Based Anesthesia
October 5, 2020
Driving to the office—even in this age of working remotely—is not an unusual activity for millions of Americans. However, it is still considered an exception to the rule for one group of healthcare workers. Anesthesiologists and anesthetists tend to be found primarily in large facilities, such as hospitals and surgery centers, rather than an office. Occasionally, however, some of these providers will indeed find themselves driving to a doctor’s office to perform an anesthetic service at the request of a surgeon or pain physician. While these services are usually billable, there are a few things that our readers should understand before agreeing to provide office-based anesthesia (OBA).
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Anesthesia Documentation from a Compliance Perspective
September 28, 2020
Virtually any compliance in-service begins and ends with a statement about the importance of accurate and complete documentation. It is an admonition that often falls on deaf ears. Whether they complete paper anesthesia records or complete the requirements for electronic anesthesia records (EARs), most providers will assure you they have accurately documented the clinical services they provided and assume that this is good enough. In most cases, this is true. It is the exceptions that put providers at risk, however.
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On Pins and Needles: Pain Management Looks at Acupuncture
September 21, 2020
We can all learn something from each other. Eastern healing and Western medicine—the key is finding what works. This naturally involves a willingness on the part of practitioners in both traditions to consider the science behind techniques they may initially find unconventional. Some are actually putting this common-sense approach into practice. Take, for example, Medicare and acupuncture. What was once taboo to the federal payer is now accepted and actually compensated when performed in connection with certain patient conditions.
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Are You Getting the Most Out of Your Anesthesia EMR?
September 14, 2020
The majority of our clients do not work in facilities that have an anesthesia electronic medical record (EMR). Despite some early trepidation about the transition from a paper record to an EMR, most installations have gone fairly smoothly. The majority of our clients report that they are reasonably happy with the new system. As is so often the case with new technology, younger physicians tended to embrace EMRs faster and more enthusiastically than their older colleagues. Although there was once a variety of companies offering an anesthesia EMR, the field has contracted considerably. Epic and Cerner now dominate the market for inpatient systems. Anesthesia Touch—a product we developed—is also a popular option for hospitals still on paper, as well as for outpatient facilities.
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Preoperative Clearance for Anesthesia: Possibilities and Perils
September 8, 2020
Sure, they sound good. The come-ons and sales pitches that permeate our daily lives are certainly enticing; the rationale they employ can be quite alluring; but the bill of goods we’re being asked to buy doesn’t always turn out as advertised. That’s why caution and discernment are essential tools for today’s consumer. This principle of caveat emptor (“let the buyer beware”) must especially apply to those in the healthcare community. Unlike the individual who simply endures a bit of frustration after purchasing a defective product, when a medical provider buys into a non-compliant process or practice, it can have serious ramifications—to include negative government action.
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Is Big Better When It Comes to Anesthesia Practices?
August 31, 2020
The disruptive impact of the coronavirus has many anesthesia practices and hospitals questioning their strategic options. The virus has introduced an additional element of uncertainty into the relationship between groups and the facilities they serve. Strategic planning should be about exploring options. Hence, the logical question is what options might arise as a result of the current crisis? Is this the time to circle up the wagons as a defensive strategy or is it time to break off and go it alone? Sometimes swifter, quicker, nimbler is the best way to strike while the iron is hot.
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When Payment Is in Doubt: New ABN Form for Anesthesia and Pain
August 24, 2020
As a provider of medical services, your first priority is to take care of your patients, but you also want to receive fair payment for that care. There are times, however, when payment may be in doubt due to the nature of the service or procedure you’re being asked to render. The fact is, not every treatment episode is going to be considered medically necessary by the patient’s insurance plan; and where medical necessity is rejected, so is payment. In those cases where there is serious doubt about whether a service will be reimbursed by insurance, the provider may have the option of seeking payment directly from the patient. This is done by way of an advance beneficiary notice of noncoverage (ABN).
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Advance Payment Program: Time for Loan Recoupment Approaching
August 21, 2020
In early April, the Centers for Medicare and Medicaid Services (CMS) made available billions of dollars to healthcare providers through the Advance Payment Program (APP). The federal agency made clear at the time that, unlike other COVID-era relief programs, the APP amounted to a loan that providers would have to eventually pay back. Some of our readers applied for and received these emergency funds, and now the payback period is approaching.
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COVID-19 and Anesthesia: Challenge and Opportunity
August 17, 2020
One of the most interesting outcomes of the Great Depression was the emergence of the rental car business. Avis and Hertz were founded because so many Americans could not afford to buy cars. It was a classic example of American innovation. Today’s business traveler could no longer survive without Hertz, Avis, Enterprise and many others. Now that we face a different crisis with the coronavirus, the question is what new businesses or industries will it inspire.
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2021 Proposed Fee Schedule: Anesthesia Takes a Hit
August 10, 2020
The bad news just seems to keep coming. A pandemic that won’t go away, a hit to the individual’s and nation’s bank accounts, a reduction of fall sports activities, and now this—a potential pay-cut next year for those on the frontlines of the COVID crisis. On August 3, the Centers for Medicare & Medicaid Services (CMS) issued its proposed Medicare physician fee schedule (MPFS) for calendar year 2021. The following reflects some of the key takeaways from the agency’s press release regarding the proposed rule that will have direct implications for anesthesia practices.
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How Has COVID Impacted Patient Responsibility for Anesthesia Charges?
August 3, 2020
How do our clients get paid for the services they perform? The Medicare payment model has historically been typical of the industry as a whole. The intermediary evaluates the details of the claim to determine an allowable based on the current contract rate. Unless the patient has a deductible, the payment is 80 percent of the allowable. The patient is responsible for the 20 percent balance unless they have a secondary plan. The only plans that do not have a patient responsibility are Medicaid and workers’ compensation, the specific rules for which are determined by the state in which the service is being paid.
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Anesthesia Providers Ponder: Can I Bill Time for Ancillary Procedures?
July 27, 2020
This is the last in our recent series of articles focusing on anesthesia time. In this part four of our primer, we will delve into what may be the most surprising, confusing and downright frustrating element of time compliance for the anesthesia provider. Many are not even aware of this element or the rules surrounding it. Nevertheless, it is a reality that must be accounted for in many, though not all, anesthesia cases. Today, we will be addressing anesthesia time in connection with separately paid surgical procedures, such as invasive line and postoperative pain block placements.
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The Life of an Anesthesia Claim in the Age of COVID
July 20, 2020
There has been so much discussion about the drop in surgical volume resulting from the Covid-19 virus. Many of our clients saw a decrease in case volume of as much as 80 percent during the months of March and April. This of course, resulted in a serious drop in collections. Now that surgical volumes are increasing, our clients are optimistic that collections will eventually return to normal levels. Needless to say, we have to keep reminding our clients that there is always a lag. That is just the nature of medical accounts receivable.
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It’s That Time: Anesthesia Considers Labor Epidural Billing
July 13, 2020
“I think it’s time.” The husband looks at his wife with a confused brow that eventually turns to wild-eyed panic. “You mean it’s that time,” he anxiously asks. “Yes,” she calmly replies. This is immediately followed by the customary rush to find the car keys and the classic ignoring of speed limits along the way to the hospital.
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Paycheck Protection Program Application Extension Alert!!
July 6, 2020
On July 4, 2020 President Trump signed legislation that extends the filing time for small businesses to apply for the Paycheck Protection Program (PPP). The former deadline was June 30th and is now extended to August 8th. Applications for the program and updated interim rules can be found on the US Treasury
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The Value of Operating Room Utilization Data to Anesthesia Practices
July 6, 2020
Effective business managers have learned that one cannot manage what one cannot measure. Anesthesia providers have long since learned how valuable timely and reliable data is in the management of their practices. Why does this not apply to their role in operating room management? Anesthesia practices should pride themselves on having more and better data about what happens in the operating room suites they work in. Why does this not translate into an invaluable role as operating room managers? Sadly, the fact is that too many providers see themselves as captive to a system over which they have no control. Operating room utilization and staffing requirements may have more to do with compensation and benefits levels than any other factor, including managed care contracting and the effectiveness of billing and collections.
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It’s About Time: More Anesthesia Time Tenets
June 29, 2020
Earlier this month, we began a multi-part primer on anesthesia time, with part one focusing specifically on the basics of anesthesia start time and stop time. In this part-two article, we will turn our attention to a few other issues involving time that anesthesia providers must master in order to fully comply with the billing rules. It may be surprising to some to see just how many time elements come into play in an anesthesia case beyond just start and stop time. Understanding and consistently following all of these time tenets will be the key to keeping you in good stead with prospective auditors, as well as preventing your billing staff from sending you requests for further clarification. With that said, let us now turn to our time topics for today.
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Ten Weeks of COVID-19: A Look at Anesthesia’s Journey
June 22, 2020
Two questions preoccupy the thinking of most anesthesia providers these days: what will the new normal look like, and how soon will we get there? Most of our clients are starting to see surgical volumes pick up after the unprecedented drop-off in early March, but there is a huge divergence. Some practices are almost back to where they were in January and February, but most are not. Clearly, multiple factors determine surgical volume. State COVID guidelines are just one aspect of the recovery. Even where elective cases are permitted, concerns about potential exposure still determine how willing patients are to schedule needed surgeries. Most surgeons are actively soliciting their patients to schedule recommended procedures but many report a certain degree of patient resistance. The fact is that we still don’t have a handle on this pandemic, and the numbers are still going up in 21 states.
