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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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.
March 19, 2018
Anesthesia decision aids are brochures that are specially designed to walk patients through the process of determining whether they would prefer a regional or general anesthetic technique for surgery. Designed for use only when there is no medically “best” option, these aids can help anesthesia providers engage patients in the shared decision-making that is becoming a cornerstone of patient-centered care.
March 12, 2018
Legislation introduced in Virginia would direct health plans to develop protocols for paying physicians for services performed when their credentialing applications are received. The legislation could help streamline a frequently lengthy process that impacts revenue and impedes access to care. We encourage ABC clients to contact their state societies to inquire about existing or planned advocacy initiatives to simplify and shorten the credentialing process.
March 5, 2018
Bundled Payments for Care Improvement Advanced (BPCI Advanced), a new initiative from the Center for Medicare and Medicaid Innovation, was among topics of discussion at the American Society of Anesthesiologists’ practice management conference in New Orleans. We provide an overview of this program and links to resources. As in the past with other new programs, anesthesia practices may want to take this opportunity to learn, observe and see how the model unfolds.
February 26, 2018
Managed healthcare organization Anthem has released a clinical guideline stating that monitored anesthesia care and general anesthesia are not medically necessary for the majority of patients undergoing cataract surgery. We summarize the healthcare community’s response, including efforts by the American Academy of Ophthalmologists to rescind the guideline.
February 19, 2018
In ABC’s experience, issues around proper documentation of medical necessity represent the leading cause of anesthesia claims denials. While medical necessity may be thoroughly shown in the anesthesia record, we encourage anesthesia practitioners to ensure that they share this information with their billing and coding partner. ABC clients with questions are encouraged to contact their account executives.
February 12, 2018
Effective teams, including high-performing teams spanning departments, disciplines and services, are central to the development of a “culture of safety.” Hallmarks of high-performing teams include an aligned vision, complementary skills, achievable goals and metrics, participative leadership, a culture of trust and a preoccupation with failure. We present an overview of a presentation by Jeffrey S. Vender, MD, MBA, at PRACTICE MANAGEMENT™ 2018 in New Orleans.
February 5, 2018
The benefits of surveying patient satisfaction with anesthesia care are becoming increasingly evident in a competitive environment of quality reporting in which anesthesia groups can use reports of outstanding service and communication to help demonstrate value to institutions and payers. We offer highlights of a presentation on measuring patient satisfaction by ASA Board Member James R. Mesrobian, MD, FASA, at the American Society of Anesthesiologists’ PRACTICE MANAGEMENT™ 2018 in New Orleans.
January 29, 2018
Drug shortages remain a serious problem, and anesthesia providers are particularly vulnerable, with anesthesia drugs often among those in short supply. We offer a glimpse of current trends, advocacy initiatives by the American Society of Anesthesiologists and others, research on causes and potential solutions, and programs at individual institutions.