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Anesthesia Groups: Keep HIPAA Compliance on Your Radar

Summary 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 administra...
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Independent Anesthesia Group Practice: A Short Manifesto

Will Latham, MBA President, Latham Consulting Group, Inc., Chattanooga, TN"Most people will choose unhappiness over uncertainty. -Tim FerrisAnesthesia groups are facing great challenges in today's environment. I am sure you are aware of these various challenges so I won't belabor them.The question is: What do we do now?Some groups are throwing in t...
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Lawmakers Take Aim at Opioid Epidemic: What Anesthesia Providers and Pain Specialists Should Know

Summary 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 ...
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The Smart Anesthesia Group’s Guide to Defending a Payer Audit

Vicki Myckowiak, Esq. Principal, Myckowiak Associates, PC, Detroit, MIAnesthesia groups currently find themselves in the uncomfortable position of being a target of the Office of Inspector General (OIG) of the Department of Health and Human Services, the largest inspector general's office in the federal government, with approximately 1,600 people d...
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RAC Recommendations for Anesthesia Groups

Summary 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...
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Anesthesiologists Oppose Medicare Opioid Rx Changes

Summary 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...
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A Refresher for Anesthesia Practices on Business Associate Agreements: Are Your Contracts in Order?

​SUMMARY Covered entities, including anesthesia practices, are required under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to execute a contract with business associates to safeguard the privacy and security of protected health information (PHI). As the holder of the PHI, anesthesia groups should make sure they under...
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Sweat the ‘Small’ Stuff: A Checklist for More Thorough Anesthesia Documentation

Summary We review some aspects of clinical documentation to which anesthesia practices should pay close attention. No other specialty has a clinical document like the anesthesia record. The anesthesia record must serve as superbill, clinical record, quality tool and medical-legal document. In addition, each anesthesia practice has its own cust...
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American Association of Nurse Anesthetists Challenges Anthem on New Anesthesia Policy

The American Association of Nurse Anesthetists (AANA) has joined the ranks of healthcare organizations that have come out in opposition to a clinical guideline issued in February by insurance company Anthem that directs ophthalmologists to assume responsibility for anesthesia administration and patient monitoring during routine cataract surgeries....
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Anesthesia ‘Decision Aids’ to Engage Patients When There is No ‘Best’

Summary 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 d...
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Attend AIAPM 2018:Stay on Top of the Latest Anesthesia Practices

​How do you keep your team informed on the latest topics of interest to anesthesiologists, practice administrators, CRNAs and others in the anesthesia marketplace? The Advanced Institute for Anesthesia Practice Management (AIAPM) will focus on practice management issues with the goal of enlightening attendees on broader group strategy issues, ...
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State Bill to Simplify Credentialing: What Anesthesia Groups Should Know

Summary 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 ...
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News for Anesthesia Groups: ACA Repeal, ADRs, Opioid Prescribing and Medicare ID Cards

​SUMMARY This eAlert offers news briefs of interest to anesthesia practices on: the Republicans' latest attempt to repeal and replace the Affordable Care Act; the new Medicare ID number initiative and what practices should be doing now to prepare; a primer on additional documentation requests (ADRs) and why a timely response is essential; and ...
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Expanding Value in Anesthesia: Bundled Payments and the Perioperative Surgical Home

Summary 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 ...
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Anesthesiologists: Innovate and Anticipate the ‘Next Play’ to Lead the Specialty’s Move to Value-Based Care

SUMMARY Anesthesiology is in the midst of a 'Blockbuster-Netflix moment,' according to Daniel Cole, MD, immediate past president of the American Society of Anesthesiologists. By focusing on innovation and opportunities for system performance improvement, and with insight into their own leadership styles, anesthesiology leaders can help the pro...
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Anesthesia Services for Cataract Surgery ‘Not Medically Necessary’: Insurer Anthem

Summary 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 r...
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Conflicts and Kickbacks: Risks for Hospital-Based Physician Groups

Frank Carsonie, JD Chair, Health Care & Life Sciences Practice Group Benesch, Friedlander, Coplan & Aronoff LLP, Columbus, OH Nathan Sargent, JD Associate, Health Care & Life Sciences Practice Group Benesch, Friedlander, Coplan & Aronoff LLP, Cleveland, OH Hospitals and hospital-based physician groups enter various types of service ...
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Documenting Medical Necessity in Anesthesia: Think Comorbidities

Summary 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 clie...
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What Is the Value of Data and What Data Has Value? Today’s Anesthesia Management Challenge

Jody Locke, MA Vice President of Anesthesia and Pain Practice Management Services Anesthesia Business Consultants, LLC, Jackson, MI What is it that makes today's anesthesia providers so good at managing patients safely through the trauma and discomfort of surgery? While many will cite the value of experience, the most critical factor is the availab...
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Building High-Performing Teams in Anesthesia

Summary 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...
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