January 7, 2013

The 2013 CPT^® Changes and Codebook are now available to health care providers.  Overall, the 2013 changes include 186 new codes, 119 deleted codes, and 263 revised codes. In addition CPT revised 18 modifiers and updated 150 guidelines.  The very good news for anesthesia and pain management providers is only a small handful of these changes directly impact the services they routinely provide.  Following are general comments regarding the 2013 changes:

December 31, 2012

A year from now, under the Affordable Care Act (ACA), a health insurance exchange should be up and running in every state.

December 24, 2012

We would like to thank all of our clients and other subscribers to the Alert for your support over the past year.  Each Monday, copies now go out to more than 10,000 persons.  Your feedback has been most helpful in letting us know what is important to you and where we might provide further information or clarification.  Please continue to email us when you have comments or questions.

December 17, 2012

Everyone involved in the healthcare industry will inevitably learn about the confusing aspects of medical health insurance. Just when you thought you had a grasp on the insurance marketplace another complexity presents itself.  Sometimes what you might have thought of as an insurance plan turns out not to be insurance at all.

December 10, 2012

It is a question asked quite often: Is marking a check box on the anesthesia record sufficient documentation?  For medical review and for billing purposes?

December 3, 2012

Across the United States and the District of Columbia, the average anesthesia managed care contract rate during the first several months of 2012 was $67.94.

November 26, 2012

Memorial Hospital—a hypothetical “Memorial Hospital”—considers itself extremely fortunate to have renewed its contract with Associated Anesthesiologists—a hypothetical “Associated Anesthesiologists”—for another three years.   Although one newly-formed anesthesia management company (AMC) and one freshly-capitalized market leader among AMCs have approached Memorial, the hospital let the anesthesia group know that it would not be entertaining any proposal.  If Memorial were to enumerate the attributes of Associated Anesthesiologists for which it is so grateful, the list would be as follows:

November 19, 2012

Now that the elections are over, nationwide attention has turned to the so-called “fiscal cliff.”  The fiscal cliff refers to the effective date of automatic cuts in spending combined with increases in taxes mandated by law.   It has been called a year-end “perfect storm” and “taxmageddon.”  One commentator at CNN referred to the fiscal cliff as “the legislative equivalent of a slow-motion train wreck.”

November 12, 2012

As you expected, if you have been reading our Alerts, the final version of the Medicare Physician Fee Schedule Rule for 2013 contains a massive payment reduction.

November 5, 2012

There continues to be considerable confusion as to which post operative pain management services are reimbursable and the criteria for ensuring that payment for them can be consistently obtained. Part of the issue has to do with the different modes of acute pain management currently being used across the country, but another point of confusion pertains to the provider categories for each type of service. While individual payor policies may vary, the essential parameters are quite consistent across all jurisdictions.  Irrespective of what a particular group’s billing practices have been historically, it is a good time to reexamine previous assumptions and review current guidelines. The fact that a given payor has not questioned charges for a particular service historically is no guarantee that payments were received legitimately or that a subsequent audit might not uncover a significant overpayment. It should be noted that contract terms can be misleading; and all terms must be evaluated by a qualified expert to determine what services are payable and under what conditions. Many payor contracts, for example, describe what services are payable in one section and who may provide them in another. Under no circumstances, however, would it be appropriate for anesthesiologists or CRNAs to bill for post-operative pain management services provided by non-qualified providers or RNs employed by the facility.

November 2, 2012

Wisconsin Act 160 (Act 160) establishes a licensure requirement for anesthesiologist assistants (AAs).  Prior to Act 160, AAs practiced under delegated authority.  Act 160 also established the requirements for obtaining AA licensure, AA’s scope of practice, anesthesiologist supervision requirements as well as a Council on Anesthesiologist Assistants.  This announcement summarizes some of the key aspects of the new law that Wisconsin anesthesiology providers need to know.

October 29, 2012

Anesthesia services have spread far beyond the operating room over the past several decades. The demand for sedation and analgesia has gone up dramatically, reflecting not just population growth but also an increasing variety of nonsurgical procedures requiring that patients be protected against pain or prevented from moving.

October 22, 2012

With a new calendar year just over two months away, the medical and healthcare communities have begun the annual flurry of end-game activity seeking to influence payment rates.  Anesthesiologists need little reminder of the Sustainable Growth Rate (SGR) threat and the 27 percent cut in Medicare payment that will take effect on January 1, 2013, unless Congress intervenes.

October 18, 2012

F1RSTUse^TM is the first—and only—full-service EHR management platform built exclusively for anesthesiologists and pain management specialists to satisfy with ease Stage 1 of Meaningful Use as required to earn the Medicare EHR incentive payment.  It is the only product that provides the full service measures to ensure success:  tracking the necessary data points, providing reports of successful measures and ensuring that you are meeting all of the CMS requirements.

October 15, 2012

We are in the middle of the ASA Annual Meeting, which draws thousands of anesthesiologists from across the country to spend several days at meetings and lectures, all without compensation.  We know the incentive for the rank-and-file:  the opportunity to attend an incomparable array of refresher courses, panel discussions and other continuing education offerings.  Hundreds of anesthesiologists come to educate others and participate in committee and board activities as specialty leaders.

October 8, 2012

The Office of the Inspector General (OIG) within the Department of Health and Human Services has published its Work Plan for 2013.  On the list of Medicare issues on which the OIG will focus next year is the following:

October 1, 2012

The percentage of patients requiring the highest level of service in the emergency department at Faxton St. Luke’s Healthcare in Utica, NY rose 43 percent in 2009, as reported in the New York Times on September 21, 2012.  Level 5 ED visit services (CPT® code 99285) at Baptist Hospital in Nashville, TN increased by 82 percent in 2010, and by a comparable amount at Methodist Medical Center of Illinois in Peoria.  More than 80 percent of Methodist Memorial’s Medicare ED evaluation and management (E/M) claims were for Level 5 services in 2010, as they were at Yuma Regional Medical Center in Yuma, AZ in 2007.  At Baylor Medical Center in Irving, TX, 64 percent of all ED visits for Medicare patients were Level 5 services, and another 16 percent were Level 4.

September 24, 2012

October 1, 2012, as we noted in last week’s Alert, is the deadline for ambulatory surgical centers to begin reporting quality measures to CMS or face payment penalties.  October 1st is also a momentous date for hospitals, with the start of the Medicare Hospital Inpatient Value-Based Purchasing (VBP) Program.

September 17, 2012

We are in the fifth year of Medicare’s Physician Quality Reporting System (PQRS) and most anesthesiologists and nurse anesthetists are at least aware of the program, even if they are not participating.  Now it is the turn of the ambulatory surgery centers (ASCs) to start reporting quality measures to CMS or face payment penalties.

September 10, 2012

Many “Covered Entities” within the meaning of the privacy and security provisions of the Health Insurance and Portability Act of 1996 (HIPAA) are managing more and more of their patient information electronically.  Indeed, not moving to electronic health records (EHRs) may cost physicians a percentage of their Medicare remittances—or at least the loss of a potential bonus of up to $44,000—under the EHR Incentive Program, as discussed in our last several Alerts.