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?Check boxes are a very convenient way to document services provided to a patient with minimal time spent dictating or writing out everything that is done.  We see check boxes on pre-operative assessments, anesthesia records and evaluation and management service (E&M) forms, just to name a few.  Templates increase the efficiency of the clinical documentation, but are they an acceptable form of documentation?On November 9, 2012, the Centers for Medicare and Medicaid Services (CMS) issued Transmittal 438, which provides some insight into CMS’ views on the use of templates in medical record documentation and the risks, as well as some guidance.In its Transmittal, CMS stated its position on the use of templates and check boxes:CMS does not prohibit the use of templates to facilitate record-keeping. CMS also does...

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.That figure comes from the latest ASA survey of commercial fees paid for anesthesia services, published in the November issue of the ASA NEWSLETTER.  ASA fields the survey electronically every year, soliciting responses through email, committee list servs, newsletters and the website.  Whether the responses are representative of the specialty is an open question, but the overall consistency of the survey results from year to year, since it was initiated in the mid-1990s, supplies a certain measure of credibility.  The survey leverages the relatively small number of respondents by asking for the conversion factors (“CFs” or “unit rates”) for five of each group’s largest managed care contract rates.The first thing to note is that $67.94 is a weighted average of averages across up to five contracts for each of...

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.” Putting politics aside, unless new legislation is enacted between now and the end of the year, the fiscal cliff will have an impact on you and your anesthesia practice.  In this week’s Alert, we summarize some of the changes slated to take effect at the start of 2013.  This is only a summary and not tax advice.  You should consult your tax advisor regarding your response to this possible fiscal cliff.Income TaxesThe table below is based on gross income after exemptions:SingleMarried Filing JointlyCurrent Tax Bracket2013 Tax Bracket$0–$8,700$0–$17,40010%15%$8,700–$35,350$17,400–$70,70015%18%$35,350–$85,650$70,700–$142,70025%28%$85,650–$178,650$142,700–$217,45028%31%$178,650–$388,350$217,450–$388,35033%36%$388,350 +$388,350...

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: Medicare Conversion Factors  20122013Difference Anesthesia Services(national average)$21.52$15.93-26.0% Other Services$34.0376$25.0008-26.5%   As you also know, the 26% and 26.5% cuts are unlikely to go into effect.  If they do go into effect, because Congress fails to take action before December 31st, Congress will almost certainly enact a fix early in the new year, as it has done every year but one (2002) since the Sustainable Growth Rate (SGR) formula first start mandating reduction. In announcing the Final Rule, the Centers for Medicare and Medicaid Services (CMS) itself said: The final rule with comment period also includes a statutorily required 26.5 percent across-the-board reduction to Medicare payment rates for more than 1 million physicians and non-physician practitioners under the Balanced Budget Act of 1997’s Sustainable Growth...

[Author’s Note: A version of this article originally appeared in the August 2012 issue of Anesthesiology News.] In a much awaited pronouncement, on June 1, 2012, the U.S. Department of Health and Human Service’s Office of Inspector General issued Advisory Opinion 12-06 addressing the propriety of two popular schemes to extract money from anesthesiologists, the so-called “company model” and the purported “management fee.” The advisory opinion could not be more welcome: Just as Willie Sutton, the bank robber, targeted banks “because that’s where the money is,” owners of ambulatory surgery centers continue seek a share of anesthesia fees. According to a survey conducted by the American Society of Anesthesiologists, 41% of the responding anesthesia practices (125 out of 308) reported being requested by an ASC or its referring physician practice to adopt a company model. Not surprisingly, those 125 practices reported that out of the total 332 requests to participate in...