April 5,2010 Before a Medicare
Recovery Audit Contractor (RAC) may send a demand letter or a request
for records to a provider, an improper payment “issue” must first be
approved and be posted on the RAC’s website. In January of this year,
one of the first CMS-approved issues relating to anesthesia appeared on Health Data Insight’s website. HDI is the RAC for Region D, which encompasses...
afternoon, March 26th, the Senate adjourned for the “Spring District
Work Recess” without adopting legislation that would have extended
current Medicare physician payment rates through April 30, 2009. A vote
on extending those rates is scheduled for the afternoon of April 12th,
the day that the Senate returns. Readers should make sure to contact
their Senators once again to..
March 22, 2010 ABC
encourages all readers of our Alerts to familiarize themselves with the
Anesthesia Quality Institute, established by the American Society of
Anesthesiologists last year and now enrolling practices that wish to
compare their clinical and business management performance data to
We believe that the AQI and its database, the National Anesthesia
Clinical Outcomes Registry, will become vitally important to ...
March 15, 2010 A
number of our clients have asked about the medicare electronic
prescribing (eRx) bonus, which allows qualifying physicians and certain
allied health providers including nurse anesthetists to earn a second,
separate bonus on top of the potential PQRI 2 percent bonus. This year,
the eRx bonus is 2 percent of estimated allowable charges for Medicare
patients. In 2011 and 2012, the bonus will be...
March 8, 2010 Although we have discussed out-of-network billing issues in
past Alerts, today’s issue highlights other out-of-network challenges
facing physicians and facilities. For those anesthesia groups that have
strategically remained out-of-network providers, we anticipate continued
challenges as insurance companies explore new strategies for reducing
costs associated with paying for out-of-network services rendered to
October 27, 2008
Prevending Medical Identity Theft.
The Federal Trade Commission last week postponed the implementation date of the “Red Flag” rules from November 1, 2008 to May 1, 2009. During the six-month reprieve...
March 3, 2010 On Tuesday night, legislation postponing the 21.2%
SGR-driven cut in Medicare payments to physicians passed the Senate and
was quickly signed into law by President Obama. Medicare will continue
to pay at 2009 rates for another 30 days, as it did throughout January
and February 2010. This extension will...
March 1, 2010
President Obama took over the lead on health care reform (HCR)
legislation last week, on Monday releasing a set of changes to the
bills adopted by the Senate and the House of Representatives in 2009 and
on Thursday February 25th holding an unprecedented seven-hour
televised “Bipartisan Health Care Reform Summit” meeting...
February 22, 2010 Medicare Administrative Contractors (MACs), Recovery Audit
Contractors (RACs), Program Safeguard Contractors and other agencies
including the Department of Justice are becoming more aggressive in
their auditing activites. To help you stay out of their viewfinders...
February 15, 2010 When a patient follows their payer guidelines and has surgery
by an in-network surgeon at an in-network hospital, why should they be
assessed an out of network penalty if their anesthesiologisst is
non-contracted with the payer?
February 8, 2010
1. What makes pain medicine different?
2. What defines profitability for a clinical service?
3. What distinguishes successful practices?
These three linked questions were the focus of the talk presented
by ABC Vice President Jody Locke at the ASA Practice Management
Conference in Atlanta on January 30, 2010. There are two answers to the
February 1, 2010 Anesthesia practices have raised new questions about the
availability of Recovery Act funds to incentivize providers to adopt
electronic health records (EHRs) since CMS issued proposed regulations on December 30, 2009. The Cliff Notes answer is that.....
January 25, 2010 Our outside counsel, with whom we work on anesthesia
compliance matters, among others, has brought the following development
to our attention:
Pursuant to Section 302 of the Tax Relief and Health Care Act of 2006,
CMS’ Recovery Audit Contractor (RAC) Program was made permanent and was
expanded nationwide. At this point, the RAC contractors are in place
for all 50 states. RACs are permitted to...
January 19, 2010 When anesthesiologists begin receiving their Medicare payments
for services provided in January 2010, they should see no change from
their 2009 conversion factors. On March 1st, however, Medicare rates
will drop 21.2 percent- unless Congress passes legislation correcting
the impact of the Sustainable Growth Rate on which the calculation of
the annual fee schedule is based.
January 11, 2010 Do you have any questions about the Physician Quality
Reporting Initiative now that we are into 2010? Judging by our e-mail,
telephone calls, and client meetings, many anesthesia groups still have
basic questions, and the most sophisticated PQRI participants are
identifying new gaps in the official PQRI information released by CMS...
January 4, 2010 There will be many more changes for anesthesia practices in
this new year than we can report here – which is just as well, since we
are looking forward to keeping you up to date with 51 more Alerts in
2010. We open with the following items...
December 28, 2009 There is not going to be any final federal health care reform
(HCR) legislation in 2009 – but such legislation may be adopted as early
as next month. If it does pass, it will have a significant impact on
employers as well as on patients and providers. This Alert will preview
the impact on anesthesia groups, as employers, of the massive overhaul
of the United States health care system entitled the "Patient Protection
and Affordable Care Act" (H.R. 3590) passed by the Senate on Christmas
Eve, December 24th.
December 21, 2009 The new Medicare payment rules for teaching anesthesiologists and for teaching CRNAs will go into effect in less than two weeks. Recent written guidance from CMS on the reporting of time by teaching CRNAs has been confusing – contradictory, in fact. We contacted CMS and found out how CRNAs are to report their time while supervising students in two concurrent cases...
December 14, 2009 Beginning on January 1, 2010, anesthesiologists, nurse anesthetists and anesthesiologists assistants will have a new measure to report under the Physician Quality Reporting Initiative: perioperative temperature management. This addition to the PQRI brings the number of anesthesia measures to a total of three...
December 7, 2009 Do you use CRNAs? How many? Do you employ them, or does the hospital? Do you receive a stipend from the hospital, and what does it cover? How many cases do your anesthesiologists perform? What are your salaries like?...