Anesthesia Business Consultants

Weekly eAlerts Covering Regulatory Changes, Compliance Reminders &
Other Changes in the Anesthesia Industry

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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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  • A Proposed Update to CMS’s Two-Midnight Rule

    April 25, 2016

    On July 13, 2015, we informed you of CMS’s Two-Midnight Rule.  After much pushback from industry stakeholders and from the judicial system since our alert, CMS proposes to eliminate the notorious payment reduction under the Two-Midnight Rule in its FY 2017 Medicare Inpatient Prospective Payment System (IPPS) Proposed Rule (Proposed Rule).  Though not slated to be finalized until the latter part of 2016, hospitals and their partners can be optimistic that the penalty under the Two-Midnight Rule may soon be a memory. 

  • Colonoscopies Allegedly Safer Without Anesthesia Services—Really?

    April 18, 2016

    A new study appearing in Gastroenterology contends that the overall risk of complications after colonoscopy increases when individuals receive anesthesia services. This study should not lead to any restrictive payment changes. Its analysis is flawed and the actual difference between the West, to which is attributed the highest risk, and the Northeast (lowest) is a clinically-insignificant 1.5 percent, as shown here.

  • Anesthesiologists, Do You Know Where Your Ultrasound Images Are?

    April 11, 2016

    Many pain medicine procedures, and, increasingly, perioperative and critical care procedures such as central venous access are performed using ultrasound guidance (U/S).  Indeed, U/S is an integral part of many CPT® codes, e.g., 20604 [Arthrocentesis, aspiration and/or injection, small joint or bursa, (e.g., fingers, toes), with ultrasound guidance, with permanent recording and reporting].  When and where, and by whom, must those permanent images be stored?  What if another entity, such as a hospital, is responsible for storing them?  According to Sonosite,

  • Anesthesia Practices May Be Subject to the Phase 2 HIPAA Audits

    April 4, 2016

    If you receive a letter by email that begins like this:

  • Dos and Don’ts of Amending the Anesthesia Record

    March 28, 2016

    The anesthesia record, like medical records in general, should be complete and accurate at the time when the physician signs it—ideally.  In practice, it occasionally requires amendment. Given the huge role that accurate documentation plays in our medical payment system, compliance with the rules and regulations governing medical record amendments is important.  Altered medical records have great potential for fraud, especially if the added information helps to raise the level of a billable service, and no one should be surprised if auditors look at any changes closely.

  • Concurrent Cases Can Be a Problem Not Just for Anesthesiologists

    March 21, 2016

    Recent media coverage of surgeons operating in two concurrent cases raises three issues:  (1) patient safety, (2) compliance with the Medicare teaching physician billing rules and (3) transparency vis-à-vis patients.

  • The Burden of Measuring Quality in Anesthesiology and Other Physician Practices

    March 14, 2016

    Donald Berwick, MD, senior fellow at the Institute for Healthcare Improvement (IHI) (and a former CMS administrator) described nine steps to advance healthcare into “the moral era” at an IHI forum in December, 2015.  One of those steps was to “stop excessive measurement.”  Dr. Berwick said:

  • New Guidelines for Managing Postoperative Pain: Anesthesiologists Take Note

    March 7, 2016

    The American Pain Society last month released a set of Clinical Practice Guidelines on the Management of Postoperative Pain. The key recommendation in the Guidelines is for greater use of multimodal pain management strategies.

  • Protect Your Anesthesia Practice Against Ransomware Attacks

    February 29, 2016

    “Ransomware” attacks are malicious intrusions into information systems that encrypt the victim’s sensitive data and demand payment in exchange for a key to unlock the data.  They have become increasingly common in the last few years.  Since January 2013, there have been at least 100,000 cases of recorded ransomware attacks. 

  • Anesthesia Practices Must Refund Overpayments within 60 Days—Final Rule

    February 22, 2016

    The Affordable Care Act requires Medicare physicians and others to report and return overpayments within 60 days after the date when an overpayment is identified.  Four years after publishing its proposed rule, CMS issued a Final Rule on February 6, 2016 with the intent of providing “needed clarity and consistency for providers and suppliers on the actions they need to take to comply with requirements for reporting and returning of self-identified overpayments.”

  • The State of Anesthesiologists’ Exposure to Malpractice Lawsuits

    February 15, 2016

    Being sued by a patient who had a poor outcome is one of the more unpleasant experiences most doctors can contemplate.  The impact of a malpractice lawsuit can be potentially devastating to one’s financial, professional and personal well-being.  But it is not often that bad.  In a survey conducted by Medscape among 4,000 physicians (Peckham C. Medscape Malpractice Report 2015:  Top Reasons Doctors Get Sued—Anesthesiologists.  January 22, 2016), the responding anesthesiologists reported that trial resulted in a verdict for the plaintiff in only two percent of cases.  Another 33 percent were dismissed either by the court or by the plaintiff.  Twenty-four percent were dismissed from the suit either before any depositions were taken or within the first few months.  Forty-one percent settled before reaching the verdict stage, and 10 percent resulted in a verdict in the anesthesiologist’s favor.

  • MACRA Fundamentals for Anesthesiologists

    February 8, 2016

    One of the biggest takeaways from the ASA Practice Management Conference held in San Diego on January 29-31 was the need for anesthesiologists to start thinking about what the Medicare and CHIP Reauthorization Act of 2015 (MACRA) will mean for their practices.

  • Meaningful Use Update for Anesthesiologists and Pain Physicians; Hardship Exception Application

    February 1, 2016

    The Medicare requirement that eligible professionals and hospitals demonstrate “meaningful use” (MU) of electronic health record (EHR) technology has received a lot of attention from provider organizations and in the media recently.  Two significant MU developments have occurred in the last few weeks:  (1) the Centers for Medicare and Medicaid services (CMS) launched a streamlined process for claiming a hardship exemption and (2) CMS Acting Administrator Andy Slavitt stated publicly that the MU program “will now be effectively over and replaced with something better.”

  • Hospitalists and Anesthesiologists and Perioperative Medicine

    January 25, 2016

    There are more nearly 50,000 hospitalists practicing in the U.S. today and the specialty continues to grow rapidly.  A recent American Society of Anesthesiologists (ASA) Health Policy Research paper entitled “Prevalence of Hospitalists in U.S. Community Hospitals” found that between 2012 and 2013, 34 out of 50 states showed an increase in the percentage of hospitals using hospitalists and that the percentage of community hospitals using hospitalists increased by almost five percent during that period.

  • Toward Greater Accuracy in the Use of the Anesthesia Physical Status Modifiers

    January 19, 2016

    Did you know that the American Society of Anesthesiologists (ASA) has published a set of examples to guide the accurate use of the Physical Status (PS; P1-P6) modifiers?  The ASA House of Delegates approved the examples in October 2014.  They appear at

  • Will Colonoscopies Continue to Be Bread-and-Butter Procedures for Many Anesthesia Practices?

    January 11, 2016

    More than 14 million screening colonoscopies are performed each year.  Anesthesiologists and nurse anesthetists participate in a large proportion of these procedures.  There are several developments that may bring down the numbers or at least slow the rate of growth of screening colonoscopies that our readers, especially those whose practices include a significant volume of anesthesia for colonoscopy services, should note.

  • 2016 CPT® Coding and Key Reimbursement Changes For Pain Management and Anesthesia

    January 4, 2016

    We begin this new year with a list of the key changes to CPT coding and Medicare payment policies.

  • 2016 Predictions for Anesthesiologists to Ponder

    December 28, 2015

    As we barrel toward the end of 2015, let us stop briefly to consider some predictions for the year ahead in healthcare.  Below is a set of ten predictions that appeared in Fortune magazine earlier this month, along with several comments.

  • Update for Anesthesiologists on the Value Based Payment Modifier

    December 7, 2015

    CMS released the Final Medicare Fee Schedule Rule for 2016  on October 30, 2015.  The November 9th issue of F1RSTNews discussed the conversion factors for anesthesia ($22.4426) and for other services ($35.8279) and some of the changes to the measures and registry options for the Physician Quality Reporting System (PQRS).  The final rule addresses a number of other matters of interest to anesthesiologists and pain physicians.  In this issue, we will summarize developments concerning the Value Based Payment Modifier (VM).

  • Social Media 101 for Anesthesiologists and Pain Physicians

    November 30, 2015

    Are you using social media for professional purposes?  If so, you are in the vanguard of specialist physicians generally, and of anesthesiologists in particular.  Many doctors are still skeptical of the benefits, and leery of the potential to waste a lot of time.

  • Anesthesiologists Should Prepare for the Medicare Comprehensive Care for Joint Replacement (CJR) Payment Model

    November 23, 2015

    CMS has now finalized its proposal to cover total joint replacement (TJR) procedures through a bundled payment methodology.  Under the Final Rule issued on November 16, 2015, some 800 hospitals across the country will be financially responsible for all of the inpatient and postoperative care of patients undergoing total knee or hip replacements from admission until 90 days after discharge.  CMS estimates that the new bundled-payment test will cover about 23 percent of TJR surgeries for which Medicare pays and save Medicare $343 million over the five performance years of the model.