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Tony Mira, Chairman and Chief Executive Officer of MiraMed

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Tony Mira founded MiraMed Global Services, Inc. in 2005 and serves as its Chairman and Chief Executive Officer. Mr. Mira also Co-Founded MiraMed's subsidiary Anesthesia Business Consultants, LLC in March 2001 and serves as its Chairman and Chief Executive Officer. By bringing these companies together under the MiraMed moniker, he has formed one of the largest healthcare Business Process Outsourcing (BPO) companies in the United States.

Artificial Intelligence and Machine Learning in Anesthesia: Are We There Yet?

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...
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CMS’s 2019 Anesthesia-Related Payment Proposals for Outpatient and Ambulatory Services

SummaryThe 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 co...
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Becoming a Cheetah and Other Survival Tactics

In her blog, A Penned Point, early this year, Karen Sibert, MD, president of the California Society of Anesthesiologists, asked her fellow specialists to take some time during Physician Anesthesiologists Week to celebrate the specialty's accomplishments, but also to reflect on the state of the profession today, the anesthesiologist's place in the c...
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Will Anesthesia Providers be Targeted in CMS’s ‘Probe and Educate’ Audits?

SummaryTargeted 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 educa...
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CMS’s 2019 Proposed Payment Rule: Highlights for Anesthesia and Pain Management Providers

SummaryThe 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. The ...
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Adding Focus and Structure to Anesthesia Patient Handoffs

SummaryPatient 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 err...
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Blockchain Technology in Anesthesia: Disruptor or Fad?

SummaryThe 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.Among emerging technologies,...
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Anesthesiologist Supply and Demand: Trends Within the Specialty

SummaryTwo 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.Is there...
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Concurrency Defined: A Reminder for Anesthesia Providers

SummaryConcurrency 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 anest...
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Legal Cases Underscore Compliance Lessons for Anesthesia and Pain Groups: Part 3

SummaryWe 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. We continue this week with our third eAlert highlighting legal cases related to significant risk...
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What Does “Patient Satisfaction” Mean to and for Anesthesiologists?

​"Patient satisfaction" and the patient experience are considered key measures of quality and performance in our increasingly value-based healthcare system. The American Society of Anesthesiologists' Committee on Performance and Outcomes Measurement (ASACPOM) has acknowledged that "monitoring of patient satisfaction has already been incorporated in...
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A Refresher on Documentation of Anesthesia Postoperative Evaluations

SummaryTo 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..One of the issues in anesthesia ...
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Anesthesiologists and the Changing Healthcare Landscape

As we noted in our eAlert on the topic, the medical community's transition to the International Classification of Diseases and Related Health Problems 10th revision (ICD-10) has, contrary to expectations, gone fairly well so far. In fact, it has gone much better than anticipated, with rates of claims denials remaining essentially unchanged before a...
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Does Your Anesthesia Billing Partner Have Access to the Details of a Case?

Summary 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 i...
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On Waivers, ASCs and Independent Anesthesia Practice

The rules pertaining to waivers of copays are certainly worth understanding. "It is an understatement to say the consequences of inappropriate waiver practices are significant," write returning authors Frank Carsonie, JD, and Nathan Sargent, JD, in their lead article for this Communiqué.In the current era of increased federal and state governmental...
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How Are Anesthesia Practitioners Faring With the New GI Codes?

SummaryThe 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 count...
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Legal Cases Underscore Compliance Lessons for Anesthesia and Pain Groups: Part 2

SummaryLegal 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 Affordab...
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Legal Cases Underscore Compliance Lessons for Anesthesia and Pain Groups

Summary 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 Vick...
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Anesthesia Payment for the Perioperative Surgical Home

Summary 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. On...
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Anesthesia Community Speaks Out Against California Healthcare Bill

Summary 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 anest...
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