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.Under appropriate circumstances, the physician may bill for two services in a code pair and include a...

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. OCR conducted the Phase I “pilot” audits mandated by the HITECH Act in 2011 and 2012.  Among the findings, from audits of 115 covered entities (CEs), among them, 61 providers, were the following: Only 11 percent of the CEs audited had no negative observations; The smallest CEs had the greatest difficulties in complying with all three of the HIPAA Standards; More than 60 percent of the findings or observations were Security Standard violations, and 58 of 59 audited health care provider CEs had at least one Security Standard finding or observation even though the Security Standards represented only 28 percent of the total audit items; More than 39 percent of the findings and observations related to...

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. FinancialLike all other providers, ASCs are confronting declining payments.  Health insurers are squeezing their margins and ASCs are threatened by exclusion from provider networks, especially those dominated by hospitals with whose outpatient departments the ASCs might be competing.  Hospitals are rushing to create integrated networks while simultaneously growing horizontally through mergers.  Integrated networks not only lock up physicians who might otherwise refer to the ASCs; they may also limit the number of payers who will enter into contracts with...

The first thing that most of us look for when CMS publishes the Proposed and then the Final Medicare Fee Schedule Rules is the payment update.  CMS chose to say nothing about payment rates for 2015 in the Proposed Rule that appeared on July 3rd, however, because the Fee Schedule update and Sustainable Growth Rate (SGR) “calculations are determined under a prescribed statutory formula that cannot be changed by CMS.”  (CMS Fact Sheet on Proposed policy and payment changes to the Medicare Physician Fee Schedule for Calendar Year 2015.)  Instead, the current conversion factors will remain unchanged through March 2015, pursuant to the Protecting Access to Medicare Act (PAMA) of 2014.  Before Congress passed PAMA, CMS had estimated the update 2015 at -20.9 percent.  That is still a reasonable approximation—unless, as everyone hopes, the SGR is repealed or at least suspended again by legislation. The Proposed Rule nevertheless consists of 608...

This blog was written by: Neda M. Ryan, Esq.Clark Hill, PLC, Birmingham, MI When was the last time you considered investing, or renting space, in an ambulatory surgery center (ASC)? While issues of whether the transaction makes good business sense are, naturally, at the forefront of any business person’s mind, often physicians (including anesthesiologists) fail to take into account the compliance considerations that are the drivers of many of the underlying business decisions. Unfortunately, in today’s healthcare regulatory arena, no anesthesiologist can ignore the importance of ensuring compliance with State and Federal Laws when considering a relationship with an ASC. For purposes of this article, an ASC is a distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed twenty-four hours following an admission. The entity must have an agreement with the Centers...