Attorneys in various specialties are always keeping an eye out for outgoing, charismatic, smart physicians willing to provide expert testimony. Common cases in need of expert testimony include medical malpractice, personal injury, wrongful death and auto accidents. Testifying as an expert witness requires qualifications that vary from state to state. Whether you have never testified as an expert witness, or testify routinely, this article will outline some considerations to keep in mind when providing (or deciding whether to provide) expert testimony. What it Means to Serve as an Expert You may be approached to provide expert testimony as a treating physician, or in your capacity generally as an anesthesiologist or pain management specialist in a case with which you were not involved. Sometimes, the testimony of an anesthesiologist or pain management specialist will be requested simply to explain the treatment rendered to a patient. For example, if a patient was...

With the ICD-10-CM conversion deadline one year away, many professional organizations and industry experts are warning of a lack of preparation and the serious adverse effects on practice revenues.  The level of alarm and doom is not realistic nor a given outcome for the majority of anesthesiologists.  With reasonable physician diligence in documenting services completely and accurately, successful conversion is likely.  Groups should make sure that their billing companies are preparing them to meet the new documentation requirements—as ABC will do—to avoid claim processing delays or denials beginning on October 1, 2014. We want to reassure all anesthesiologists, including our clients, that the proverbial sky is not going to fall come October 1, 2014.  Let us start with a review of the facts: What is it? Beginning October 1, 2014, all health care entities must use ICD-10 codes on claim forms. This includes: Diagnosis codes (ICD-10-CM) used by all providers in...

Health insurance exchanges (HIEs) will open in every state by October 1, 2013, as mandated by the Affordable Care Act (ACA).  Their basic role will be to permit consumers to compare and purchase qualified insurance plans online.  Estimates of the numbers of individuals who will enroll in HIE plans during the six-month enrollment period that starts on October 1st vary from seven million (Congressional Budget Office) to four million (Citigroup investor survey released last Monday).  Many of these enrollees will be eligible for federal subsidies to help pay for the coverage. The issue for anesthesiologists and other physicians is whether to participate in the HIE health plans that are seeking to sign them up.  The clock is running; coverage under the HIE plans will begin as early as January 1, 2014.  This Alert will discuss the questions and considerations that will help groups decide how to proceed. Bear in mind that some...

If you are an anesthesiologist practicing in a group of 100 or more eligible professionals (EPs) and submitting claims to Medicare under a single taxpayer number, you may be subject to the Value Based Payment Modifier (VBPM) in 2015.  By 2017, all physicians participating in Fee-for-Service Medicare will be affected by the VBPM.  This Alert is intended to help anesthesiologists familiarize themselves with the VBPM. The VBPM program, as provided for in the Affordable Care Act, is designed to connect the cost and quality of medical services in order to pay for “value” rather than the quantity of care.  It combines quality measures under the Physician Quality Reporting System (PQRS) with cost measures and a payment adjustment. The VBPM and PQRS are related but independent.  Readers are reminded that EPs who do not participate in PQRS in 2013 are subject to a -1.5% payment adjustment in 2015.  Non-participation in 2014 and...

The American Medical Association (AMA) and the Medical Group Management Association (MGMA) offer tools that allow physicians, policy makers and others to evaluate the performance of a number of third party payers including Medicare. The AMA and MGMA information may help anesthesia and pain medicine groups who contract with private payers to identify potential problem areas and to prepare to negotiate for specific performance standards and remedies for non-compliance. The AMA’s National Health Insurer Report Card contains metrics on the timeliness, transparency and accuracy of claims processing by the payers analyzed.  The information in the latest annual report is derived from a random sampling of 2.6 million electronic claims submitted by more than 450 physician practices across 41 states in February and March of this year to Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corporation, Humana, Regence, United Healthcare and Medicare.  Below are some of the key findings...