Anesthesia Industry and Market News: eAlerts
eAlerts are the latest industry information regarding regulatory changes, helpful compliance reminders, or any number of relevant topics in the fast-paced, ever-evolving speciality of anesthesia.
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June 7, 2010 You already know that basing private health plan payment rates on the Medicare Fee Schedule would bankrupt your practice. We do not know of any anesthesia practice that has ever been forced to accept 100% of the Medicare conversion factor, but there are some groups that have agreed to 150% or other multiples of Medicare
June 1, 2010 Today, June 1st, is the date that the 21.2 percent un- Sustainable Growth Rate (SGR) reduction in Medicare payments to physicians is going to go into effect. Once again Congress is trying to pass legislation that will give physicians a very small increase for now and defer solving the SGR problem until a later date – 2014, under the American Jobs and Closing Tax Loopholes Act of 2010 (H.R. 4213). The Senate adjourned without taking up the bill, however; it will return on June 7th.
May 24, 2010 Pinnacle Anesthesia Consultants of Dallas, TX terminated shareholder Neal Fisher, MD in a manner that cost the group more than $10 million by the time the state court appeal was over.
May 17, 2010 Anesthesia groups should review their compliance programs in light of the emphasis on combating fraud and abuse in the Patient Protection and Affordable Care Act (PPACA). While physicians account for a very small part of the billions of dollars paid out erroneously each year, the risks of flunking an audit and being faced with overpayment or fraud liability outweigh the hassle of compliance for most practices.
SPECIAL ALERT Tell Washington to Use the Health Care Reform Law to Review the Anesthesia Conversion Factor
May 12, 2010 Four key members of the U.S. House of Representatives are seeking support from their colleagues for a letter to the Department of Health and Human Services requesting a review of the accuracy of Medicare's payments for anesthesia services
May 10, 2010 Many anesthesiologists are uncertain how the Revised Anesthesia Services Interpretive Guidelines issued by the Centers for Medicare and Medicaid Services (CMS) in December 2009 changed documentation requirements.
May 3, 2010 Medicare pays about 33 percent of average commercial payments for anesthesia services. This fact, well known to anesthesiologists, was one of the findings in a report published by the Government Accountability Office in 2007. The GAO study was based on a representative sample of anesthesia services performed in 41 Medicare payment localities. Other specialties, including pain medicine, collect an average of 80 percent or more of their commercial rates for Medicare patients.
April 26, 2010
The Health Information Technology for Economic and Clinical Health Act (HITECH) provisions of the 2009 Recovery Act establish financial incentives starting in 2011 for “eligible professionals” (EPs) who are meaningful users of certified electronic health record (EHR) technology. EPs who qualify may receive up to $44,000 over 5 years, beginning in 2011...
April 19, 2010 As of January 1, 2010, Medicare stopped accepting claims for consultation services (CPT® codes 99241– 99245 and 99251–99255). Instead, physicians are to report the appropriate evaluation and management (E&M) codes:
- 99201-99205 (New Office/Outpatient Visit)
- 99211-99215 (Established Office/Outpatient Visit)
- 99221-99223 (Initial Hospital Care)(inpatient)
- 99231-99233 (Subsequent Hospital Care)
CMS claimed that the change was budget neutral in that the total relative value units assigned to the consultation codes were redistributed among the E&M codes. Many anesthesiologists and other physicians are finding, however...
RAC Rules : HITECH Act Electronic Health Record Incentive Program- Bonus or Penalty for Anesthesiologists?
April 12, 2010
Most physicians have heard that they are going to be eligible for a federal payment of up to $44,000 between 2011 and 2015 if they use an electronic health record (EHR). Anesthesiologists continue to wonder, however, whether they will qualify for the bonus, since they rarely invest directly in EHRs or electronic anesthesia records, relying more typically on the hospital’s information technology (IT).test
They will not qualify, in all likelihood. First, anesthesiologists do not use...
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.....