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...

March 29,2010 On Friday 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 national benchmarks.

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 patients...

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 first question.....

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?...