eALERTS
eAlerts are the most up-to-date industry information regarding regulatory changes, helpful compliance reminders, or any number of relavant topics in the fast-paced, ever-evolving speciality of anesthesia.
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Risks to Anesthesiologists Who Remain Out of Network
Although we have discussed out-of-network billing issues in past Alerts, today’s issue highlights other out-of-network challenges facing physicians and facilities. For those anesthesia groups that have strategically remained out-of-network providers, we anticipate continued challenges as insurance companies explore new strategies for reducing costs associated with paying for out-of-network services rendered to patients...More
21.2 Percent Medicare Payment Cut Postponed Again
On Tuesday night, legislation postponing the 21.2% SGR-driven cut in Medicare payments to physicians passed the Senate and was quickly signed into law by President Obama. Medicare will continue to pay at 2009 rates for another 30 days, as it did throughout January and February 2010. This extension will......More
After the Summit: Health Care Reform Update for Anesthesiologists
March 1, 2010President Obama took over the lead on health care reform (HCR) legislation last week, on Monday releasing a set of changes to the bills adopted by the Senate and the House of Representatives in 2009 and on Thursday February 25th holding an unprecedented seven-hour televised “Bipartisan Health Care Reform Summit” meeting...More
Common Compliance Risks for Anesthesiologists in 2010
February 22, 2010Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), Program Safeguard Contractors and other agencies including the Department of Justice are becoming more aggressive in their auditing activites. To help you stay out of their viewfinders...More
Anesthesia Patients and Out of Network Penalties
February 15, 2010When a patient follows their payer guidelines and has surgery by an in-network surgeon at an in-network hospital, why should they be assessed an out of network penalty if their anesthesiologisst is non-contracted with the payer?More
Making Pain Medicine Profitable
February 8, 20101. What makes pain medicine different?
2. What defines profitability for a clinical service?
3. What distinguishes successful practices?
These three linked questions were the focus of the talk presented by ABC Vice President Jody Locke at the ASA Practice Management Conference in Atlanta on January 30, 2010. There are two answers to the first question.........More
Medicare Will Not Pay Anesthesilogists for "Meaningful Use" of EHRs
February 1, 2010Anesthesia practices have raised new questions about the availability of Recovery Act funds to incentivize providers to adopt electronic health records (EHRs) since CMS issued proposed regulations on December 30, 2009. The Cliff Notes answer is that......More
RAC-Region D to Review Anesthesiologists' Claims for Evaluation and Management Services
January 25, 2010Our outside counsel, with whom we work on anesthesia compliance matters, among others, has brought the following development to our attention: Pursuant to Section 302 of the Tax Relief and Health Care Act of 2006, CMS’ Recovery Audit Contractor (RAC) Program was made permanent and was expanded nationwide. At this point, the RAC contractors are in place for all 50 states. RACs are permitted to...More
Anesthesia Conversion Factors If There Is No Legislation
January 19, 2010When anesthesiologists begin receiving their Medicare payments for services provided in January 2010, they should see no change from their 2009 conversion factors. On March 1st, however, Medicare rates will drop 21.2 percent- unless Congress passes legislation correcting the impact of the Sustainable Growth Rate on which the calculation of the annual fee schedule is based. More
2010 PQRI Requirements and Anesthesiologists' Choices
January 11, 2010Do you have any questions about the Physician Quality Reporting Initiative now that we are into 2010? Judging by our e-mail, telephone calls, and client meetings, many anesthesia groups still have basic questions, and the most sophisticated PQRI participants are identifying new gaps in the official PQRI information released by CMS....More
What's New for Anesthesia Practices in 2010
January 4, 2010There will be many more changes for anesthesia practices in this new year than we can report here – which is just as well, since we are looking forward to keeping you up to date with 51 more Alerts in 2010. We open with the following items...More
Anesthesia Groups as Employers and Health Care Reform
December 28, 2009There is not going to be any final federal health care reform (HCR) legislation in 2009 – but such legislation may be adopted as early as next month. If it does pass, it will have a significant impact on employers as well as on patients and providers. This Alert will preview the impact on anesthesia groups, as employers, of the massive overhaul of the United States health care system entitled the "Patient Protection and Affordable Care Act" (H.R. 3590) passed by the Senate on Christmas Eve, December 24th. More
COMPLIANCE UPDATE: Teaching CRNAs and Concurrent Student Cases
December 21, 2009The new Medicare payment rules for teaching anesthesiologists and for teaching CRNAs will go into effect in less than two weeks. Recent written guidance from CMS on the reporting of time by teaching CRNAs has been confusing – contradictory, in fact. We contacted CMS and found out how CRNAs are to report their time while supervising students in two concurrent cases...More
Reporting Anesthesia PQRI Measures In 2010
December 14, 2009Beginning on January 1, 2010, anesthesiologists, nurse anesthetists and anesthesiologists assistants will have a new measure to report under the Physician Quality Reporting Initiative: perioperative temperature management. This addition to the PQRI brings the number of anesthesia measures to a total of three...More
Anesthesia Practice Benchmarks - Did You Know?
December 7, 2009Do you use CRNAs? How many? Do you employ them, or does the hospital? Do you receive a stipend from the hospital, and what does it cover? How many cases do your anesthesiologists perform? What are your salaries like?...More
What Anesthesiologists Need To Know About Medicaid’s Contracted Auditors
November 30, 2009Although there has been a lot of discussion on the Medicare Recovery Audit Contractor (“RAC”) program, little attention has been paid to the first national Medicaid audit program resulting from the creation of the Medicaid Integrity Program (“MIP”). As part of the MIP...More
What Will Tort Reform Do for Anesthesiologists?
November 23, 2009Senate Majority Leader Harry Reid released his long-awaited healthcare reform (HCR) package on Wednesday, November 18, 2009. More
The Public Option in the House Healthcare Reform Bill: What Does it Mean for Anesthesia Practices?
November 16, 2009"In the debate over health care reform, no issue has produced more fury and sound bites than the question of whether to include a government-run insurance plan."More
The Impact of the 2010 Medicare Fee Schedule on Anesthesiologists
November 9, 2009As expected, Medicare physician payments are set to drop by one-fifth beginning on January 1, 2010. More precisely, the "Final Rule" on the Physician Fee Schedule released by the Centers for Medicare and Medicaid Services (CMS) on October 30th calculates the reduction at 21.2 percent. The good news is...More
Anesthesia and Related Targets in the 2010 O.I.G. Work Plan
November 2, 2009The Department of Health and Human Services’ Office of the Inspector General (OIG) Work Plan for fiscal year 2010 contains one item of specific interest to anesthesiologists and pain physicians who perform transforaminal epidural injections. More
Anesthesiologists' PQRI Reports- Here We Go Again
October 26, 2009Anesthesia practices that successfully participated in the Physician Quality Reporting Initiative (PQRI) in 2008 have begun receiving notices of payment from Medicare. Some practice administrators are wondering More
Healthcare Reform: A Satisfying Week for Anesthesiologists
October 19, 2009On Sunday, October 11, the health insurers’ lobby turned on the Obama Administration by releasing a report showing that health care premiums for a typical family would grow by $1,000 to $4,000 per year under the Senate Finance Committee’s Healthcare Reform (HCR) package. More
Taxing Anesthesiologists and Others to Pay for Expanded Health Insurance Coverage
October 12, 2009While Congress looks at surtaxes on high-income individuals and at taxes on “Cadillac” health plans as a means to help pay for healthcare coverage for the uninsured and underinsured, a number of States have already implemented or considered “provider taxes.” More
ABC Sponsors “A Celebration of Advocacy” at the First Annual Opening Session of the American Society of Anesthesiologists’ Annual Meeting
October 5, 2009ABC is very proud to be the sole sponsor of ASA’s Celebration of Advocacy, a major inaugural event that will take place on Saturday, October 17, 2009 from 11:30 a.m. to 1:00 pm at the Ernest N. Morial Convention Center in New Orleans. More
Anesthesiologists’ Hospital Stipends: Exceed “Fair Market Value” at Your Stark Peril
September 28, 2009On August 25, 2009, Covenant Medical Center (“Covenant”) in Waterloo, Iowa agreed to pay the United States $4.5 million to resolve allegations that it violated the False Claims Act. More
FAQs on RACs for Anesthesiologists
September 21, 2009If you have not yet discovered the Frequently Asked Questions (FAQs) feature of the Centers for Medicare and Medicaid website (www.cms.hhs.gov), you are overlooking an increasingly valuable tool. More
What Anesthesia Practices Should Know About Medicare Local Coverage Determinations and “Articles”
September 14, 2009This week we would like to elaborate on the content and importance of the articles and policies published by the Part B (physician services) Medicare Administrative Contractors (MACs), formerly known as your local Medicare carriers. More
Swan-Ganz Values Increase; HITECH Act Regulations Tighten Up HIPAA Privacy and Security Requirements
September 8, 2009The Centers for Medicare and Medicaid Services (CMS) has announced an increase in the valuation of facility practice expenses CPT® code 93503, “Insertion and placement of flow directed catheter (e.g., Swan-Ganz) for monitoring purposes.” More
Dear CMS: ASA Presents Its Views on the 2010 Medicare Fee Schedule
August 31, 2009Today is the deadline to file “comment” letters with CMS regarding the proposed Medicare Physician Fee Schedule for the calendar year 2010. More
Where Do Payer Policies on Medical Necessity Come From?
August 24, 2009You wonder whether your patient’s insurance will cover monitored anesthesia care (MAC) for an upper GI endoscopy, or for a pain medicine procedure. For that matter, how many pain injections will the payer cover? More
Why Are The Payers and Policymakers So Sure That Physicians Are Overcharging?
August 17, 2009As Congress finally left Washington, D.C. for the August recess, it was clear that the cost of universal coverage was becoming the dominant challenge in healthcare reform. More
The RACS (Recovery Audit Contractors) Begin to Show Their Stuff
August 10, 2009ABC and other consultants are hoping that by educating you on avoiding and surviving a “RAC attack,” the arrival of the Medicare Recovery Audit Contractors will provide as little drama as did your software when 1999 rolled over. More
Pain Medicine Is Still in Medicare’s Fraud-and-Abuse Viewfinder
August 3, 2009A number of pain medicine practices have recently found themselves targeted for audits by Medicare contractors. Audit letters from contractors including NGS and WPS have focused on medical necessity issues... More
Medical Direction Documentation: Choose a Documentation Method That Works Best for You
July 27, 2009Fortunately or unfortunately, depending on your perspective, CMS has not provided specific instruction on exactly how this documentation must be accomplished. More
What Happened Late Last Week in Healthcare Reform?
July 20, 2009Right now the healthcare reform (HCR) comet is moving so fast that the best use of these Monday Alerts is to keep you abreast of major developments affecting anesthesia practice. More
Epidurals and Blocks Are Still Separately Payable
July 13, 2009You may have started receiving unexpected denials from Medicare for epidural injections and nerve blocks performed together with a number of invasive monitoring line insertions and injection/aspiration procedures. THESE DENIALS MAY BE WRONG... More
Proposed Changes to the Medicare Physician Fee Schedule for 2010
July 6, 2009The Centers for Medicare and Medicaid Services (CMS) published the “proposed rule” for the 2010 Physician Fee Schedule on Wednesday July 1st. More
A Brief Refresher Course on the National Practitioner Data Bank
June 29, 2009The numbers of anesthesiologists reported to the National Practitioner Data Bank (NPDB), which was created by the Health Care Quality Improvement Act of 1986 (HCQIA), continue to be very low. More
For Your Strategic Planning: Ambulatory Surgery Center and Hospital Trend Data
June 22, 2009One thing that anesthesia practices can do to prepare for next year and the year beyond, while watching the convolutions of healthcare reform, is to keep up with information on the changing marketplace. More
'Tis the Season
June 15, 2009Today President Obama will deliver a major speech at the American Medical Association’s annual meeting in Chicago. The President will use this opportunity to push for a government sponsored health plan to compete with private insurance. More
Health Care Reform - What Does "Public Option" Mean?
June 8, 2009You cannot open a newspaper, periodical or health-related website without seeing announcements about new developments in the race to define the future U.S. health care system. More
CAHPS®: An Introduction to Measuring Patient Satisfaction
June 1, 2009In 1995, the federal Department of Health and Human Services launched the CAHPS® program to develop standardized survey protocols asking patients to evaluate the interpersonal aspects of health care services. More
Urgent! Healthcare Reform Is Real and Fast Approaching Make Your Voice Count Now
May 25, 2009Federal health care reform legislation is taking shape quickly. More
Will The Federal Stimulus Package Help Pay For Your Anesthesia Practice's Health Information Technology?
May 18, 2009Medicare will pay eligible professionals, defined as physicians, up to $44,000 over a 5-year period if they: More
Your Other Hospital Contracts (The Medical Staff Bylaws)
May 11, 2009One half or more of all anesthesia groups have service contracts with hospitals and/or ambulatory surgical centers. More
Measuring and Demonstrating Quality - On Your To-Do List
May 4, 2009The last few years have seen an explosion of interest not just in practice and operating room management information, but also in data that tend to demonstrate quality. More
Where Does Your Anesthesia Practice Find the Data?
April 27, 2009We are all data-maniacs. Very few decisions in anesthesia practice are made without someone asking, “Where are the data?” More
Why One Anesthesiologist Likes His Computerized Anesthesia Record - In His Own Words
April 20, 2009I am writing to you today to share my experience with implementing a computerized anesthesia record and my vision of the future use of these systems. More
Medicare's Online Provider Enrollment System is Up and Running
April 13, 2009If you enjoy preparing and filing your income tax returns, you are going to have a field day enrolling in Medicare. More
Time and Again
April 6, 2009Provisions relating to time periods or duration in hospital and employment contracts are a focus of occasional intense negotiations. More
FTC's "Red Flag Rules" Begins May 1st
March 30, 2009ABC addressed this topic in an e-blast last October, and also in February 2009. We are providing this additional information. More
Anesthesia Start and Stop Time: Do All Providers in Your Group Apply the Same Definition?
March 23, 2009It is without question that anesthesia time is one of the most critical elements in anesthesia billing making it an important compliance focus area for any anesthesia group. More
Should Anesthesia Run the OR?
March 18, 2009The answer to the question “Should Anesthesia Run the Operating Room?” is: More
The UCR Reimbursement System is Code Blue
March 9, 2009A year-long investigation into the out-of-network payments by the Attorney General of the State of New York, Andrew M. Cuomo, resulted in a ground-breaking report. More
The 2009 Stimulus Bill HIPAA Changes Impacting Anesthesia Practices
March 2, 2009The Health Information Technology for Economic and Clinical Health Act (“HITECH Act” or the “Act”) included in the “Stimulus Bill” significantly expands HIPAA privacy and security provisions. More
Anesthesia Practice Developments Regarding Stark and Anti-kickback
February 23, 2009A recent Federal appeals court decision just paved way for a qui tam whistleblower to proceed with a False Claims Act (“FCA”) case. More
Anesthesia Top 10 Must Know For 2009
February 16, 20092009 promises to be a year with many changes in regulations, anesthesia coding and even legislation affecting our practices, and we hope that we are providing you with a valuable service by summarizing the top 10. More
New Blues Contracts Reward Quality
February 9, 2009Several new contracts between Blue Cross Blue Shield of Massachusetts (BCBSMA) and providers reflect concepts that could well be the basis for pay-for-performance negotiations with anesthesiologists down the road. More
Special Alert
February 5, 2009Anesthesiologist Tom George, MD has just announced that he is planning to run for Governor of Michigan. He is asking for thoughts, ideas and suggestions and we encourage you to contact and support him. More
Electronic Medical Records in Anesthesia - Are We Getting Closer?
February 2, 2009The Finance Committee proposed an estimated $17.9 billion for investing in HIT. The Appropriations Committee’s measure would provide $5 billion for incentives to adopt electronic health records. More
Anesthesiologists' Hospital Relationships in the 2009 Recession
January 26, 2009Anesthesiologists’ relationships with their hospitals were the focus of several excellent presentations at this year’s ASA Practice Management Conference, from which we have just returned. More
Safety and Crises in Aviation and in Anesthesiology Practice
January 20, 2009Anesthesiology adopted some of the theory and techniques of the aviation industry in becoming one of the great success stories in increasing patient safety. More
Pain Medicine and the PQRI
January 12, 2009This year, as in 2007 and 2008, the Physician Quality Reporting Initiative does not contain any measures designed specifically for the subspecialty of pain medicine. More
PQRI 2009
January 5, 2009Whether you participated in the PQRI in 2008 and plan to continue or whether you are ready to begin reporting the PQRI measures in 2009, we would like to summarize the changes for you. More
How to Report TEE for Monitoring
December 27, 2008Our Compliance department recently fielded a question regarding the appropriate coding for intraoperative transesophageal echocardiographic (TEE) monitoring. The question, specifically, was whether it would be appropriate to report the placement of a TEE probe with CPT™ code 93313 for monitoring purposes. More
Anesthesiology Leaders Look at the Specialty Ten Years Down the Road
December 15, 2008Four thought leaders looked at the future of the specialty in a panel discussion – the Robertazzi Memorial Panel -- that we believe merits the attention of every anesthesiologist practicing today. More
More On "Never Events" - Wrong Site Surgery
December 8, 2008Three more “never events” – adverse events that should ideally never happen to inpatients – for which Medicare recently proposed to hold hospitals financially responsible are... More
How Much Do You Know About "Never Events"?
December 1, 2008Among the most recent are articles on the new Medicare regulations that limit-payments to hospitals for treating patients for events that should never have occurred – the Hospital Acquired Conditions (HAC) regulations. More
New Medicare ABN Form Will Become Mandatory on 3/1/2009
November 24, 2008Medicare allows physicians and other providers to collect fees from patients for services that are not covered by the Medicare program if they have alerted the patients of their potential liability using an "Advance Beneficiary Notice" (ABN). More
Ultrasound and Place of Service Are Targets of Interest in the 2009 OIG Work Plan
November 17, 2008The number of ultrasound services – including the use of ultrasound guidance for peripheral nerve blocks -- billed to Medicare and other payers continues to grow rapidly. More
The RAC Program Is a Headache for Medicare, Too
November 10, 2008Medicare Recovery Audit Contractors (RACs) are private companies that review Medicare professional and facility claims and are paid a contingency fee for any overpayments (and yes, underpayments) they can identify. More
4.76% Increase in Medicare Anesthesia Conversion Factor For 2009
October 31, 2008The Medicare conversion factor (CF) for anesthesia services will increase by nearly 5 percent to $20.92 on January 1, 2009. More
What Do You Need To Do About The FTC's "Red Flag" Rules?
October 27, 2008The Federal Trade Commission last week postponed the implementation date of the “Red Flag” rules from November 1, 2008 to May 1, 2009. During the six-month reprieve, physicians will have two tasks. More
2007 PQRI Online Participation
October 9, 2008If you have not yet seen the official report on your individual and/or group participation, you may want to do so now. More
Medicare is Watching Facet Joint Injection Claims
September 29, 2008Sixty-three percent (63%) of all the claims for facet joint injections submitted to Medicare in 2006 were coded incorrectly, according to a report issued by the HHS Office of the Inspector General (OIG) on September 17, 2008. More
Open Access to Financial Management & Consulting
September 9, 2008At Anesthesia Business Consultants, LLC (ABC) we don’t want to limit your access to Management Support Services because you are satisfied with your current billing solution. More
One Anesthesiology Group's Success in Quality Tracking
August 28, 2008If yours is among the many anesthesiology practices searching for good ways to document clinical quality improvement, you will be interested in the article below, which appeared in Health Leaders Magazine on August 11, 2008. More
PQRI: Medicare Pays Out $36 Million to 2007 Participants
August 14, 2008Anesthesiologists and other providers have begun to receive their bonus payments for successfully reporting the applicable Physician Quality Reporting Initiative (PQRI) measures in 2007. More
The Medicare Bill Becomes Law: Payment Restored
July 16, 2008The suspense is over. The Medicare Improvement for Patients and Providers Act of 2008, H.R. 6331, has become law, and anesthesiologists and others will benefit from the following changes: More
Reminder: Call Your Senator and ask him/her to Help Pass
July 8, 2008Use the unified grassroots hotline, coordinated by the AMA and the Medical Group Management Association, at 800.833.6354 to call your senators TODAY. More
Medicare Will Hold Claims to Give Congress Time to Act
June 30, 2008The Centers for Medicare and Medicaid Services (CMS) will temporarily hold claims for services provided on or after July 1st in the hope that Congress will act quickly to stop the 10.6% payment cut. More
Ten Percent Medicare Cut Goes Forward - For Now
June 27, 2008The U.S. Senate failed yesterday, June 26, to pass the Medicare bill that would have averted the July 1st automatic 10.6% cut in Medicare payments to physicians. More
Call Your Senators Now to Support the Legislation Preventing the 10.1% Medicare Payment Cut
June 10, 2008Congress must pass legislation quickly to stop the deferred 10.1% cut in the Medicare conversion factor from taking effect on July 1st, 2008. More
Fospropofol, MAC, and Endoscopy
May 14, 2008A new anesthetic agent that might inspire more gastroenterologists and other physicians to administer deep sedation themselves is soon going to be on the market. More
Aetna's Reversal
February 28, 2008One month ago, it seemed certain that Aetna was going to implement its new “medical necessity” policy limiting the circumstances under which it would pay for anesthesia for screening upper and lower gastrointestinal endoscopies. More
PQRI 2008
January 25, 2008Contained within is information we hope will help guide your decision as to what measures you might want to report. More
ASA to Aetna: Medical Necessity is a Medical Decision
January 15, 2008Immediately after sending you our message about the new Aetna policy on anesthesia for endoscopy, we received a copy of a letter, also with Friday's date, from Jeffrey L. Apfelbaum, M.D., ASA President, to Aetna's Chief Medical Officer Troyen A. Brennan, M.D, M.P.H. . More
MAC for Endoscopy
January 11, 2008Aetna has announced that it will stop paying for anesthesia services for upper and lower GI endoscopies in healthy patients effective April 1, 2008. More
Latest Anesthesia Conversion Factors
January 9, 2008We are pleased to announce the national average CF is $19.96, up $3.87 from $16.09 in 2007. More
Medicare Conversion Factor Increase
December 21, 2007Aetna has announced that it will stop paying for anesthesia services for upper and lower GI endoscopies in healthy patients effective April 1, 2008. More
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