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 25, 2012
Another Medicare compliance deadline approaches, and it has attracted a fair amount of attention. The good news is that it will apply to few pain physicians and even fewer anesthesiologists. Sometimes it is necessary to explain a new rule or requirement just so that our readers know not to worry. This is one of those times.
June 18, 2012
On-time case starts can make the difference between profitable and unprofitable operating rooms. There are multiple causes for late starts, among them clinical complications, unavailable instruments or supplies, unavailable laboratory reports or other paperwork, delays in room turnover and late arrivals on the part of surgeons, patients, and yes, anesthesiologists and nurse anesthetists.
June 11, 2012
Owners of ambulatory surgical centers (ASCs) often wish to receive a share of the professional fees paid to their anesthesiologists and nurse anesthetists. ASC owners and anesthesiologists and CRNAs have adopted—or at least proposed—numerous corporate and contractual structures over the last few decades to accomplish this transfer of revenues. The federal Anti-Kickback Statute (AKS), which prohibits a broad range of payments for referrals, has generally caused conservative lawyers to advise against such arrangements. Some attorneys and other advisors who are less risk-averse have helped their clients to go ahead.
June 4, 2012
Inspector General Daniel Levinson of the Department of Health and Human Services has stated in his Spring 2012 Semiannual Report to Congress that his office expects to recover $1.2 billion from audits ($483 million) and investigations ($748 million) concluded during the first half of 2012. Between October 2011 and March of this year, the OIG also brought 346 new criminal cases and 138 civil actions.
May 29, 2012
The EHR Incentive Program, often dubbed “Meaningful Use” (MU), has been surrounded by questions and confusion among anesthesiologists and practice administrators since its inception. Currently, the majority of anesthesiologists and pain physicians are classified as an Eligible Professional (EP) under the Medicare portion of Meaningful Use and most of the public conversation is centered on that program. However, the Medicaid option offers more flexibility and financial incentive which raises the question, “How does the Medicaid EHR Incentive Program differ from the Medicare portion?”
May 21, 2012
Patient AB underwent a rotator cuff reconstruction in January, more than four months ago. You billed the health plan that Mr. AB’s hospital record indicated. The health plan denied the claim on the ground that Mr. AB was not enrolled. You then billed Mr. AB directly for $1072.50 your usual and customary charges for anesthesia for a 120-minute open procedure on the shoulder joint (CPT™ code 01630, 15 units x $75 conversion factor) and an epidural for post-operative pain (CPT™ code 64415, $97.50).
Anesthesiology Plays a Role in Coordinating Management of Knee Replacement Patients, Contributing to Better Outcomes
May 14, 2012
“Coordinated care” is one of the key concepts in health system reform. It is central to the cost savings and quality improvements expected from Accountable Care Organizations, value-based purchasing and the medical home. It is also the basis of the American Society of Anesthesiologists’ model, the perioperative surgical home.
May 7, 2012
The Affordable Care Act (ACA) requires providers including physicians to report and refund known overpayments within 60 days, or, for providers that submit cost reports, by the date the corresponding cost report is due. The parameters of this mandate are unclear, but the duty to refund overpayments exists regardless. After summarizing some of the problems with the ACA provision and with CMS’ proposed regulations implementing the statute, we will offer some practical suggestions on compliance.
April 30, 2012
Do you check your professional association’s web site regularly? There is more practice-related information there than you may realize. One recent addition to the resources on the American Society of Anesthesiologists web site (www.asahq.org) is worth your special attention. The ASA Committee on Quality Management and Departmental Administration (QMDA) has produced a comprehensive set of questions for anesthesiologists and others involved in perioperative patient care that can guide the development of a quality program tailored to your own department.
April 23, 2012
About 60 individuals attended the discussion of compensation strategies moderated by Stephen E. Comess, Executive Director, United Anesthesia Services, P.C. Mr. Comess got the ball rolling on responses to twelve prepared compensation management scenario questions by giving each member of the audience a playing card; if the card matched another one drawn by Mr. Comess, that member provided the first response to the next question.
April 16, 2012
CMS has announced the selection of the first 27 Accountable Care Organizations (ACOs) to participate in the Medicare Shared Saving Program. The 27 organizations have agreed to be responsible for improving care for nearly 375,000 beneficiaries in 18 states through better coordination of services among hospitals, physicians and other providers..
April 9, 2012
Consolidation in the hospital sector has proceeded at a rapid pace in the last few years. Hospitals, like anesthesiologists and other health care professionals and organizations, are seeking the advantages of combined size to secure their future in a marketplace undergoing a revolution with an unknown outcome. Oral argument before the Supreme Court on the constitutionality of the Affordable Care Act, discussed in our Alert of April 2nd, did nothing to mitigate the uncertainty.
April 2, 2012
The United States Supreme Court allocated more time to oral argument on the constitutionality of the Affordable Care Act (ACA) last week than it had to any other case in the past 50 years. Four distinct questions were before the Court during six hours of argument spread over three days.
March 26, 2012
Another dragon is slinking away, although it isn’t yet slain. On February 15, 2012, Health and Human Services Secretary Kathleen G. Sebelius announced that “HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).” In other words, medical practices no longer need to ensure that they will be ready for ICD-10 by October 2013.
March 19, 2012
CMS has just updated the Medicare conversion factors (CFs) for anesthesia services. The new national, unadjusted CF is $21.52, up from $21.41 for the first two months of 2012. Download the list of locality-adjusted CFs here.
March 12, 2012
Last week saw the launch of the latest version of the iPad – and the beginning of the end, perhaps, of the IPAB.
The Independent Payment Advisory Board (IPAB) was created by the Patient Protection and Affordable Care Act (ACA) in 2010. IPAB is responsible for recommending specific proposals to contain the growth rate of Medicare spending if spending per capita is projected to exceed targets also established by the ACA. From 2015 through 2019, that target is based on measures of inflation. Starting in 2020, the target is based on the growth of the gross domestic product plus one percentage point.
Electronic Health Records – Proposed Stage 2 Meaningful Use Requirements Still Not Relevant to Anesthesiologists
March 5, 2012
The Centers for Medicare and Medicaid Services (CMS) has just issued a proposed rule that will make it more difficult than ever for anesthesiologists and pain physicians to qualify for the Medicare or Medicaid electronic health records (EHR) incentive. There will be a 60-day comment period, after which CMS will review the feedback and publish a final rule this summer.
February 27, 2012
Every private anesthesia group in the United States knows that practice management companies (PMCs) in the business of acquiring and operating anesthesia practices are growing rapidly. This is part of a general acceleration in health care merger and acquisition activity driven by healthcare reform and by the economic uncertainty of the last few years. Physician practices have become one of the fastest-growing targets; larger entities such as health systems, insurance companies and PMCs are buying up hospital-based specialties with a view toward participating in accountable care organizations (ACOs) and receiving bonuses for improving quality and decreasing costs.
February 20, 2012
Have you heard about the federal privacy and security compliance audit pilot program? The Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of the 2009 stimulus package, requires the Department of Health and Human Services (HHS) to conduct periodic audits to ensure covered entities and business associates are complying with the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules and Breach Notification standards. To implement this mandate, the HHS Office of Civil Rights (OCR) is piloting a program to perform up to 150 audits of covered entities to assess privacy and security compliance. The pilot phase began in November 2011 and will conclude by December 2012.
February 13, 2012
In any financial transaction, the person holding the money is at an advantage. Getting money back from someone who should not have been paid is harder than not making the payment in the first place. CMS knows this, and that is why it is placing a new emphasis on prepayment review of claims. Originally slated to begin on January 1, 2012 the prepayment review initiative will now formally launch in June. The number of prepayment reviews is going to increase from 1.2 million to 2.7 million claims per year.
February 6, 2012
Last week’s Alert discussed the growing trend toward including performance measures in contracts between hospitals and anesthesia groups. We identified clinical quality, efficiency and patient satisfaction measures developed by the Surgical Care Improvement Project (SCIP), the Medicare Physician Quality Reporting System (PQRS), the American Society of Anesthesiologists (ASA), the Anesthesia Quality Institute (AQI), Press-Ganey and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). All of these measures can be the basis of hospital or ambulatory surgery center contracts for performance-based payment.