ICD-10 is coming, as we have all heard many times.  Will full implementation be here on October 1, 2014, though, or on October 1, 2015?  As of the time this is written, the Senate is expected quickly to take up the House-passed Protecting Access to Medicare Act of 2014 (H.R. 4302), legislation that will prevent Medicare payment cuts from going into effect on April 1st—and that contains a provision delaying the implementation of ICD-10 for a year.  Whether we are six months or 18 months from the start date, however, it is none too early for clinicians to gain an understanding of what ICD-10 will require of them, as well as to practice meeting the new requirements. We have all heard, too, that ICD-10-CM (“CM” stands for “Clinical Modification” and distinguishes the codes used for diagnosis from those used to identify procedures, the ICD-10-PCS or “Procedural Coding System” codes) requires more...

Patients who receive an advance premium tax credit under the Affordable Care Act (ACA) may lose their insurance coverage if they fail to pay their premiums—and leave their providers holding the bag.  With more than 4.2 million individuals now signed up for policies through the ACA health insurance exchanges, every provider is at some risk of loss.  There are steps that anesthesia practices can take to avoid such losses. A little-known ACA rule gives patients who purchase subsidized coverage through the exchanges a 90-day grace period before their coverage is canceled for nonpayment of premiums.  Although insurers are required to pay for claims for services provided during the first 30 days of the grace period, they are permitted to pend any claims submitted for services performed during the 31st through 90th days.  They may ultimately deny such second- and third-month claims if the patient never makes the missed payment.  The patient...

The 2014 Current Procedural Terminology® (CPT) edition will have a total of 335 changes, including 175 new codes, 107 revised codes and 47 deleted codes for specialties.     No Anesthesia CPT codes were deleted, revised, or added for 2014. Changes to the 2014 CPT codes may impact some ASA 2014 CROSSWALK® determinations or base units. Anesthesia providers should ensure that they understand the impact of potential revenue or compensation changes due to additions or revisions to the ASA 2014 CROSSWALK (Please refer to Appendix A – Summary of Additions and Revisions in the 2014 ASA CROSSWALK for a complete list of the additions or revisions).   Pain management providers should take note of the additions and deletions in the chemodenervation subsection of the nervous system section of CPT 2014.   Nearly one-quarter of this year’s CPT code changes resulted from an ongoing two-year effort to revise gastroenterology codes to capture...

Attorneys in various specialties are always keeping an eye out for outgoing, charismatic, smart physicians willing to provide expert testimony. Common cases in need of expert testimony include medical malpractice, personal injury, wrongful death and auto accidents. Testifying as an expert witness requires qualifications that vary from state to state. Whether you have never testified as an expert witness, or testify routinely, this article will outline some considerations to keep in mind when providing (or deciding whether to provide) expert testimony. What it Means to Serve as an Expert You may be approached to provide expert testimony as a treating physician, or in your capacity generally as an anesthesiologist or pain management specialist in a case with which you were not involved. Sometimes, the testimony of an anesthesiologist or pain management specialist will be requested simply to explain the treatment rendered to a patient. For example, if a patient was involved...

Most anesthesiology practices provide services in ambulatory surgical centers (ASCs), and quite a few anesthesiologists have investment interests in ASCs.  With more than 5,400 Medicare-certified ASCs in the United States, 1.8 percent more than in 2012, a look at the characteristics of successful facilities and at the challenges they face should be worthwhile. Meeting the marketplace challenges is the foundation of success.  Topping the list of challenges for ASCs today, now that the implementation of the Affordable Care Act is underway, are the following: Attracting and retaining surgeons and other physicians who will contribute to the facility’s bottom line.  Securing coverage, high quality and a referral base have always been key, but as more and more physicians opt for hospital employment, the pool of unaffiliated physicians is shrinking.  More than half of new physicians are taking jobs with hospitals rather than entering private practice.  Twenty-nine percent of physicians were working directly...