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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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.
Anesthesia Business Consultants to Aid Anesthesiologists in Securing the Benefits of Meaningful Use through Complete EHR with F1RSTUse
October 18, 2012
F1RSTUseTM 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:
A Warning for Anesthesiologists and Pain Physicians about Increased Billings through Better Technology
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.
September 4, 2012
Last week, we announced the availability of a new web-based electronic health record (EHR) that will permit anesthesiologists to satisfy the Meaningful Use requirements for the Medicare EHR Incentive Program. Although this technology, F1RSTUse, is relatively simple, requires little additional data entry and is an option for ABC clients and non-clients alike, it will not be the best solution for every reader. Those of you who are not in a position to implement F1RSTUse or any EHR will be interested in a new hardship exception created by CMS when it released the final regulation on the Stage 2 Meaningful Use requirements on August 23, 2012.
New Technology Enables Anesthesiologists and Pain Management Specialists to Attest to Meaningful Use
August 27, 2012
A web-based electronic health record that allows anesthesiologists to satisfy the Meaningful Use requirements for the Medicare EHR incentive program is now available from ABC. ABC is very pleased to announce F1RSTUse, the first complete EHR platform built exclusively for anesthesiologists and pain management specialists to satisfy easily Stage 1 of Meaningful Use as required to earn the Medicare EHR incentive payment. Stage 1 requirements remain in effect for the next several years; one of the major changes of the August 23rd final rule was to extend the deadline to meet Stage 2 criteria until 2014. Other changes contained in the 672-page rule (PDF) will be reviewed in future Alerts.
Effective Hospital-Anesthesia Group Contracting: Understanding the Relationships Between Finance, Operations and Compliance
August 20, 2012
Preparing for negotiations requires an appreciation of the other side’s needs, wants, values and constraints. Anesthesiologists who have contracts with their hospitals or surgery centers are in a continuous cycle of negotiations—as soon as one contract is signed, it is time to start working toward the next agreement. One good place to start in understanding the facility’s position is to look at the advice hospitals are receiving from their consultants. Below is an article recently written for that audience by ABC Vice President for Regulatory Affairs & Research Joette Derricks, CPC, CHC, CMPE, CSSGB. This article addresses hospital employment of physicians who bill using RBRVS Relative Value Units, and of course anesthesiologists use the Relative Value Guide’s Base and Time Unit methodology and typically have group exclusive contracts to provide services to the hospital’s patients, but the discussion below can be read with the differences in mind. It is important to know that hospitals may not even realize that anesthesia services have a unique relative value system. Relative Value Units are billed for pain medicine, critical care, and invasive monitoring lines.
August 13, 2012
Patients who go out of network can present serious collections problems for the physicians who do not participate in the network. Managed care organizations (MCOs) often send the check to the patient in order to pressure physicians to sign participation agreements, leading to the necessity for practices to collect directly from the patients, something that is especially challenging for hospital-based anesthesiologists and other physicians who do not have ongoing relationships with their patients.
August 6, 2012
Many, if not most, anesthesia practices provide services at ambulatory surgical centers (ASCs) as well as at hospitals. Some 11 percent of anesthesiologists have invested in the ASC as part owners, according to Medscape’s Anesthesiology Compensation Report: 2011 Results. Others invest their energy in contracts to staff ASCs. In either case, it is important to know the economic condition and value of one’s ASC.
July 30, 2012
Anesthesiologists and pain physicians who have been receiving bonuses for participating in Medicare’s Physician Quality Reporting System (PQRS) should continue to do what they have been doing. The proposed Fee Schedule rule (NPRM) for 2013 does not contain any new requirements affecting those who are already successfully participating, as we noted summarily in last week’s Alert.
July 23, 2012
It comes as no surprise that the 27 percent cut mandated by the Sustainable Growth Rate (SGR) formula remains in place for now and will take effect on January 1, 2013, if Congress fails to act. Fear of the economic cliff that the entire country faces with mandatory spending reductions and the expiration of tax cuts early next year will undoubtedly affect how Congress deals with the SGR for 2013; what we cannot predict now is how.
July 16, 2012
CMS has proposed to begin paying certified registered nurse anesthetists (CRNAs) for providing certain pain management procedures on a nationwide basis. The discussion in the proposed rule on the Medicare Physician Fee Schedule for calendar year 2013, issued on July 6, 2012, sets forth the history and the considerations in expanding the types of services for which CRNAs may bill Medicare.
July 9, 2012
State governments are under severe financial pressure. In the last few years, many of them have stepped up their efforts to collect unclaimed property held by private entities such as medical practices. Every state has an “escheat” or unclaimed property statute that places the burden on those holding such property to deliver it to the treasury or commerce department if the owner cannot be found. Escheatment is the general rule that abandoned or unclaimed property (of all kinds) becomes the property of the state.
July 2, 2012
The Supreme Court’s decision on the fate of the Patient Protection and Affordable Care Act (PPACA or, more commonly, ACA) is due to be announced at 10:15 on Thursday morning, June 28. We are not jumping the gun by beginning to write this Alert ahead of the decision – the take-away message is that whether the ACA stands or falls, in whole or in part, anesthesiologists need to continue developing their role in perioperative care.