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 speciality of anesthesia.
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November 17, 2014
The last two issues of the Alert reviewed changes to the Physician Quality Reporting System (PQRS) and to the Value-Based Payment Modifier (VM) announced in the Final Fee Schedule Rule for 2015. This week we will note for the record some of the most meaningful numbers in the Final Rule—the conversion factors—and explore developments regarding two of CMS’ transparency ventures, the Physician Compare website and the Open Payments program.
November 10, 2014
CMS released the Final Rule on the Physician Fee Schedule containing next year’s Physician Quality Reporting System (PQRS) requirements on October 31, 2014. As expected, Measure #30, Timing of Antibiotic Prophylaxis-Administering Physician, has been deleted from the list of measures available for either claims-based or registry reporting. So has the Back Pain Measures Group (Measures #148-151) and Measure #142, Assessment for Use of Anti-Inflammatory or Analgesic Over-the-Counter (OTC) Medications, but CMS did not ultimately remove Measure #109, Osteoarthritis: Function and Pain Assessment, from the list.
November 3, 2014
The Final Fee Schedule Rule for 2015 applies the 2017 Value Based Payment Modifier to all anesthesiologists, CRNAs and AAs, regardless of group size, and increases the amount of payment at risk for groups with 10 or more eligible professionals) to 4 percent.
October 27, 2014
Numerous anesthesiologists have expressed confusion about the requirements for reporting Physician Quality Reporting System (PQRS) measures next year. It is very important that every eligible professional (EP) successfully participate in the PQRS program in 2015; failure to do so will mean a two-percent reduction in their Medicare payments in 2017.
October 20, 2014
Anesthesia time “starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area,” according to the Medicare regulations and the ASA Relative Value Guide®, or “begins to prepare the patient for the induction of anesthesia” as stated in the CPT® Anesthesia Guidelines. What do those words mean—and can there be any remaining controversies after all these years?
October 13, 2014
Anesthesiologists are wondering how to respond to questions about an article that appeared in the New York Times on September 20, 2014, reporting on a $117,000 bill received by a spinal fusion patient from a neurosurgeon who had assisted in his procedure.
October 6, 2014
On October 1, 2014, the start of the fiscal year for hospitals, Medicare’s maximum penalties for “preventable” readmissions increased from two percent to three percent. At the same time, CMS added three new conditions, including two frequently performed orthopedic procedures, to the list of conditions for which readmissions are deemed preventable, which now consists of the following:
September 22, 2014
It is unusual to open a health policy periodical without seeing the words “Accountable Care Organization,” or, more frequently, “ACO.” Are these entities as successful as they are visible?
September 15, 2014
Many medical services and procedures can be performed either on their own or in conjunction with another service or procedure. The National Correct Coding Initiative (CCI) identifies pairs of services that a physician cannot normally report for the same patient on the same date of service. The two services may be mutually exclusive, as when one is performed only on female patients and the other only on males. Most commonly, the reason for the linkage—the CCI “edit” that bundles the two services and prevents separate payment—is that the second service in the pair is a component of the more extensive service performed by the same physician for the same patient at the same encounter. An example familiar to anesthesiologists is the bundling of postoperative pain management procedures with an anesthetic delivered through the same catheter.
September 9, 2014
"Properly structured, arrangements that compensate physicians for achieving hospital cost savings can serve legitimate business and medical purposes. Specifically, properly structured arrangements may increase efficiency and reduce waste, thereby potentially increasing a hospital’s profitability." (Office of the Inspector General, Advisory Opinion No. 07-22, December 28, 2007.)
September 2, 2014
HHS’ Office for Civil Rights (OCR) is about to begin a new round of audits to determine the extent of providers’ and their business associates’ compliance with the HIPAA privacy, security and breach notification rules.
August 25, 2014
The “two-midnight rule” was established by the 2014 Medicare inpatient prospective payment rule. According to the policy, inpatient admissions extending through at least two midnights generally qualify for Medicare Part A payments. Surgical procedures, diagnostic tests and other services are presumptively appropriate for inpatient hospital admission and payment when (1) the physician “reasonably” expects the patient to require a stay that crosses at least two midnights and (2) admits the patient to the hospital based upon that expectation. Inpatient stays lasting fewer than two midnights are considered and should be billed as outpatient or observation services under Medicare Part B.
August 18, 2014
One of our readers asked us recently what his group needed to report under the Physician Payments Sunshine Act. The answer: nothing. The Sunshine Act, which is part of the Affordable Care Act, requires pharmaceutical and medical device manufacturers to report payments and other items of value worth more than $10, as well as certain ownership interests held by physicians and immediate family members. (See our Alert of August 5, 2013, Drug Manufacturers’ Payments to Anesthesiologists Are Now Reportable under the Sunshine Act.) It does not impose any tasks on physicians.
August 11, 2014
We recently had the opportunity to talk with one of our favorite surgeons about what she wants from her anesthesiologist or care team. Some of the items on the list below will be very familiar—so much so that it’s surprising that the issue still comes up. Others are specific to our surgeon’s specialty, otolaryngology, they may sensitize readers to analogous concerns affecting other specialties.
August 4, 2014
Ambulatory or outpatient anesthesia accounts for approximately 60 percent of surgeries in the U.S. today. The majority of anesthesia practices provide services at one or more of the 5,300 Medicare-certified ambulatory surgical centers (ASCs). The challenges faced by ASCs—whether hospital-owned or independent—affect us all. In order to be your ASCs’ valued partners, anesthesiologists and nurse anesthetists need to understand how healthcare’s challenges in general and ASC’s challenges in particular affect your facilities.
July 28, 2014
Some of the most controversial provisions of the Affordable Care Act (ACA) are those that require individuals to either sign up for health insurance or to pay a tax. Differing interpretations of the statutory language regarding the tax credit or “subsidy” that would enable lower-income individuals to afford coverage have given opponents of ACA a hook on which to hang a small but powerful legal weapon. Contrary to the claims (and hopes) of some observers, recent federal Appeals Courts decisions are not the death knell for Obamacare, however.
July 21, 2014Edit HTML Source
In a health plan featuring a “narrow network” (NN), the carrier substantially reduces the number of participating physicians, hospitals and other providers. Limiting the panel to providers offering lower prices is nothing new. In the mid-1990s, HMOs and PPOs sparked a backlash from patients and a multitude of state laws requiring that insurers include any willing provider in their networks. The dynamic has changed since the Affordable Care Act (ACA) went into effect, however.
July 14, 2014
The Proposed Rule for the 2015 Medicare Fee Schedule would eliminate the PQRS antibiotic prophylaxis measure, would reinstate the 2014 values for the laminar epidural injections, and would revise the definition of “screening colonoscopy” in recognition of the role of anesthesia—among numerous other changes.
July 7, 2014
Medicare and most commercial payers will pay anesthesia practices for locum tenens physicians who temporarily substitute for regular physicians. Know your carriers’ rules and make sure that you don’t forfeit any payments for services provided.
June 30, 2014
Keeping patient information confidential has become a major challenge since we all began storing so much of it in electronic form. Computers, tablets and smart phones containing unsecured electronic Protected Health Information (ePHI) go missing and are reported in the press on at least a weekly basis.