Anesthesia Industry and Market News: eAlerts
eAlerts are the latest industry information regarding regulatory changes, helpful compliance reminders, or any number of relevant topics in the fast-paced, ever-evolving specialty of anesthesia.
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August 13, 2018
Within five years, more than half of hospitals will have begun using artificial intelligence, including machine learning, to support clinical care and business functions, a survey has found. We offer current information on the emerging technology’s expansion and acceptance in medicine and healthcare, along with insights on potential applications in anesthesia.
August 6, 2018
The proposed rule for the Outpatient Prospective Payment System and the Ambulatory Surgery Center Payment System for 2019 includes proposals to change payment policy for non-opioid postsurgical pain management drugs, expand reimbursement for anesthesia services for some knee surgeries to outpatient settings and remove questions about pain communication from patient surveys.
July 30, 2018
Targeted Probe & Educate, a medical review process introduced by the Centers for Medicare and Medicaid Services in late 2017, identifies providers with high claim error rates or unusual billing practices for items and services that pose the greatest financial risk to Medicare. We present an overview of the process, which focuses on educating providers as a means of reducing claims denials.
July 23, 2018
The proposed Medicare Physician Fee Schedule for 2019 includes a slight increase in the anesthesia conversion factor as well as some changes to the Quality Payment Program and a significant overhaul of documentation requirements for Evaluation & Management services. CMS is accepting comments on the proposal until September 10, 2018.
July 16, 2018
Patient handoffs are a significant source of errors in intraoperative and perioperative settings. Efforts to reduce these errors often succeed at first, but do not result in behavior change that lasts. A highly structured six-stage patient handoff implementation strategy developed at Midland Memorial Hospital in Texas has reduced handoff errors by half and generated improvements and behavior changes that have been sustained since the strategy’s introduction three years ago.
July 9, 2018
The use of blockchain technology in healthcare could help solve problems of interoperability, privacy, security, transparency and patient access to information, transforming the sector, according to proponents. We explore potential uses for this emerging technology in healthcare and medicine, including anesthesia.
July 2, 2018
Two new studies point to an increased demand for medical specialists, including anesthesiologists, in the coming years and decades. We review reports from the American Association of Medical Colleges and recruitment firm Merritt Hawkins, and offer thoughts on the implications of these findings for anesthesia groups and practitioners.
June 25, 2018
Concurrency is the number of cases an anesthesia provider is involved in at a given moment in time. It applies to all anesthesia cases performed by any type of provider and to all insurance companies. Because the accurate documentation of time is so important in this aspect of billing, we recommend using a single time piece to document anesthesia start and stop times and the consistent use of a 24-hour clock, which has been shown to reduce errors.
June 18, 2018
We review takeaways from the Advanced Institute for Anesthesia Practice Management on recent legal cases of interest to anesthesia and pain practices pertaining to incorrect billing for anesthesia time and violations of the Anti-Kickback Statute.
June 11, 2018
To clarify one of the more confusing issues in anesthesia, we offer an overview of the documentation requirements for and distinctions between three types of anesthesia postoperative visits: 1) Conditions of Participation; 2) anesthesia postoperative evaluation; and 3) postoperative pain follow-up evaluation.
June 4, 2018
The transition from paper-based anesthesia records to electronic anesthesia records has created new coding and billing challenges for anesthesia groups. Expanded clinical documentation requirements now require coders to access the preoperative note, intraoperative note, operative report and postoperative note. Problems with access to this information can slow the billing process. Therefore, it is essential for your billing and coding team to have access to the full details of a case to ensure accuracy and completeness, code correctly and submit the claim promptly to the appropriate payer.
May 29, 2018
The changes in base unit values for anesthesia services for upper and lower endoscopy procedures for 2018, along with the replacement of two endoscopy codes with five more specific codes, were expected to have a negative financial impact on many anesthesia practices. An analysis of data for a representative sample of clients across the country reveals that the impact of these changes has not been as extensive as originally predicted. We review findings related to volume of cases performed, units billed and payer mix.
May 21, 2018
Legal cases presented at the Advanced Institute for Anesthesia Practice Management offer valuable reminders to anesthesia practitioners and pain specialists regarding the importance of documenting medical necessity for urine drug test screens, including quantitative tests, and compliance with the 60-day overpayments provision of the Affordable Care Act.
May 14, 2018
Anesthesia and pain practices should stay abreast of risk areas not only nationally, but also locally, through their branch office of the U.S. Department of Justice, in order to help ensure compliance and protect their groups. We highlight two cases presented at the Advanced Institute for Anesthesia Practice Management by attorney Vicki Myckowiak, Esq., and will explore additional cases from her presentation in future eAlerts.
May 7, 2018
A growing body of evidence shows that implementing a perioperative surgical home (PSH) can yield important quality improvements, operational efficiencies and cost savings for hospitals, including reductions in length of stay and readmissions. However, many anesthesia groups have questions regarding the payment aspects of this model. One option is the creation of a co-management agreement between the physicians and the hospital in which physicians receive both fixed and variable portions of compensation. We offer an overview of a presentation on the monetization of the PSH at the recent Advanced Institute for Anesthesia Practice Management.
April 30, 2018
The California Health Care Price Relief Act (AB 3087) proposes the creation of an appointed Commission that would “control in-state health care costs and set the amounts accepted as payment by health plans, hospitals, physicians, physician groups, and other health care providers.” We offer an overview of the bill as a heads up to anesthesia providers that the measure could set a precedent if it became law.
April 23, 2018
The second round of audits by the Office of Civil Rights of compliance with the Health Insurance Portability and Accountability Act (HIPAA) may be over, but HIPAA enforcement has not subsided. Anesthesia and pain groups, and their business associates, risk exposure to civil or criminal penalties if they don’t comply with the administrative, technology-related and physical processes and procedures to safeguard protected health information required under HIPAA.
April 16, 2018
We provide an overview of recently proposed legislation from the Senate Health, Education, Labor and Pensions Committee (HELP) and the Health Subcommittee of the House Energy and Commerce Committee to address the opioid crisis in the United States, including a large number of bills related to Medicare and Medicaid payment and coverage that could affect anesthesia and pain groups.
April 9, 2018
Changes to the Recovery Audit Program could be coming in 2018 that would lead to a less punitive, less burdensome and more educational and preventive approach by the government to identifying and correcting improper Medicare payments. Nonetheless, anesthesia practices are advised to be prepared for an audit. We offer recommendations to help groups plan and monitor the audit and appeal process.
April 2, 2018
Changes to the rules regarding opioid prescriptions through Medicare Part D for 2019 include a “hard edit” for opioid prescriptions at or above a cumulative daily equivalent of 90 milligrams of morphine; no more than a seven-day supply of opioid medication for opioid naïve patients; and restrictions on concurrent prescribing of opioids and opioid potentiators, such as gabapentin and pregabalin. We summarize the anesthesia community’s response.
March 26, 2018
We review some aspects of clinical documentation to which anesthesia practices should pay close attention.