Thursday, October 1, 2015 is the date on which all providers must start using ICD-10 diagnosis codes on their claims.  We cannot overstate the importance of compliance.  Claims must contain a valid ICD-10 code in order to be paid.ABC, as part of our commitment to compliance, is stepping up our efforts to help clients make a successful transition by offering an ICD-10 hotline.  Beginning October 1st the ABC ICD-10 hotline, staffed by ICD-trained coders, will be available to handle your urgent questions.  If you need help selecting the appropriate ICD-10 code, reporting services that span October 1st, figuring out what further information you need and where to find it, or answering any other questions regarding the new codes, we encourage you to call the ICD-10 hotline between the hours of 8:00 a.m. and 6:00 p.m. EST.Clients will be given the number for the ICD-10 hotline by their ABC client services representative...

Anesthesia billing is complex and riddled with a minefield of potential compliance issues. Thoughtful anesthesia groups have effective compliance programs in place, designed to minimize the risk of government allegations of fraud and abuse. When crafting and maintaining an effective billing compliance program it is helpful to understand which areas of anesthesia billing have been the subject of legal action. Moreover, like it or not, when a compliance officer is able to point to specific instances in which anesthesia providers have been subject to criminal or civil penalties, s/he is more able to obtain the highest level of compliance from otherwise recalcitrant providers. This article will provide information on where to find details on legal cases impacting anesthesia providers and discuss strategies for implementing the lessons that can be learned from a thorough understanding of the cases. How to Find the Cases The government understands the value of publicizing the cases...

What does it mean when an anesthesiologist signs a patient’s medical record?  What happens if the anesthesiologist’s signature is missing?In general, a signature has three basic purposes:Intent. The signature indicates confirmation that the signing party reviewed and approved the content or that s/he authored the document and approved the content.Integrity. The signature protects the integrity of the document against a claim that the entry was invalid or that it had been altered.Identity. The signature identifies the signing party.In the healthcare context, for medical review purposes, Medicare requires that the treating or ordering practitioner authenticate the services in question, with very few exceptions.  The method used must be a handwritten or electronic signature.  (Program Integrity Manual Chapter 3 Section 3.3.2.4)The point of the practitioner’s signature in patients’ medical records, operative reports, anesthesia records, orders and, test findings is to demonstrate that services reported to Medicare have been accurately and fully documented, reviewed...

“No man is an island, entire of itself; every man is a piece of the continent, a part of the main” begins John Donne’s famous poem. Anesthesiologists have come to realize that not only are they “a piece of the continent” that is their group, but that they are interdependent on their hospital or health system. The anesthesiologist’s and the group’s well-being is bound up with that of their institution, and perhaps with the health and welfare of other entities as well. The hospital “continent” is under enormous pressure to improve quality and to hold down costs, and so, therefore, is the “country” that is the anesthesia department. If the incumbent anesthesia groups are not properly managing their costs and quality, the chances are that their hospitals are looking for alternatives. ABC Vice President Jody Locke’s latest article for the Communiqué, Why Utilization and Productivity Metrics Matter, walks readers through the...

Next year, all physicians in groups of ten or more eligible professionals (EPs) will be subject to the Medicare Value-Based Payment Modifier (VM).  Larger groups with 100 or more EPs are already seeing VM adjustments based on their 2013 performance. In 2017, the VM will apply to all physicians, whether they are in solo practice or are in a group with two or more EPs.  And in 2018, payments to nurse anesthetists and anesthesiologist assistants will also reflect the impact of the VM.  It is time for us to familiarize ourselves with the Physician Feedback Program and the Quality and Resource Use Reports (QRURs) that will let physicians find out how they are doing, in terms of the quality and cost metrics that will determine the VM payment adjustment, and compare themselves to their peers. VM Recap As we stated in our November 3, 2014 Alert (What Anesthesiologists Need to Know...