Anesthesia Industry eAlerts
Sent to subscribers every Monday morning, our eAlerts deliver timely updates on regulatory, legislative and practice management developments of interest to anesthesia professionals.
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eAlerts
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Most Anesthesiologists Will Be Exempt from Medicare Electronic Prescribing Penalties
June 6, 2011
The deadline for submitting at least ten Medicare claims for services involving an electronic prescription (eRx) is just 25 days from now. The Medicare eRx Incentive Program requires “eligible professionals” to submit ten claims with modifier G8553, indicating the use of an eRx, between January 1 and June 30, 2011, or else be subject to a one percent reduction in their payments in 2012. “Eligible professionals” include physicians, nurse anesthetists and anesthesiologist assistants. Groups participating in the eRx group practice reporting option (GPRO) also face a payment adjustment. This Alert will use the words “anesthesiologist” and “physician” to cover all eligible professionals. We will not address the GPRO because of its likely irrelevance to anesthesia practices. -
Anesthesiologists’ and CRNAs’ Error Rates in Reporting PQRS Measures
May 31, 2011
Although anesthesiology has one of the highest rates of participation in the Physician Quality Reporting Initiative (PQRI, now the Physician Quality Reporting System or PQRS), the specialty also has one of the highest error rates in reporting—nearly 50 percent. -
More Facet Joint Injection Pain
May 23, 2011
Anesthesia and pain medicine practice managers who keep up with the National Correct Coding Initiative already know of an important change that went into effect on April 1, 2011: facet joint injections (CPT® codes 64490-64495) are now bundled with sacroiliac joint injections (27096). There are no exceptions. The change also applies to vertebroplasty, kyphoplasty, and IDET. -
Developing Leaders in Anesthesia
May 16, 2011
An increasing number of anesthesia groups struggle with getting the younger partners engaged in leadership roles. This problem exposes several other issues within the group such as a concern over the transition from one generation to the next, overworking a few partners, and stale approaches to group management. -
Anesthesiologists Visit Congress
May 9, 2011
Several hundred anesthesiologists, including a generous proportion of residents, came to Washington D.C. last week to participate in the annual Legislative Conference organized by the American Society of Anesthesiologists. -
Compliance Update for Anesthesiologists
May 2, 2011
The Medicare and Medicaid programs continue to lose large amounts of money to fraud and abuse. In 2010, the amount recovered by the Centers for Medicare and Medicaid Services (CMS) exceeded $4 billion. During the first quarter of this year, Medicare’s bounty hunters, the Recovery Audit Contractors (RACs), collected $162 million in overpayments, up from $75.8 million in the last quarter of 2010. The sheer magnitude of the recoveries explains the Office of the Inspector General’s (OIG’s) ongoing strong interest in detecting and prosecuting fraudulent billers – and its prophylactic efforts to educate physicians, hospitals, medical equipment suppliers and others on how to avoid fraud. -
Anesthesiologist and CRNA Participation Rates in the Physician Quality Reporting Initiative (PQRS), and New Compensation Data
April 25, 2011
Anesthesiologists had the second-highest rate of participation in the PQRS (then known as the PQRI, or Physician Quality Reporting Initiative) in 2009. Nearly 17,500 anesthesiologists, or 41.1% of those eligible, reported PQRS measures on their Medicare claims, second only to emergency physicians (62.8%). The average participation rate for all eligible professionals was 20.91 percent. Almost 12,000 nurse anesthetists, or 29.3% of eligible CRNAs, participated in the program. -
Preparing Your Anesthesia Practice for the 5010 Electronic Transactions Standard
April 18, 2011
This Alert is for readers who need a basic familiarity with the 5010, in time for the compliance deadline, i.e., January 1, 2012. -
ACO Proposed Rules – Will the Potential Waivers From Medicare Fraud Laws Benefit Anesthesiologists?
April 11, 2011
It is no surprise that on March 31, 2011 the Centers for Medicare and Medicaid Services (CMS) released its long-awaited Notice of Proposed Rulemaking regarding the Medicare Shared Savings
Program (the Shared Savings Program) and ACOs (Proposed Rule)—a product of Section 3022 of the Affordable Care Act. By way of clarification, Section 3022 requires the Department of Health and Human Services (HHS) Secretary (Secretary) to establish the Shared Savings Program, which will incentivize providers and suppliers to create and operate ACOs, by January 1, 2012. -
Anesthesia Practice Cost and Revenue Data
April 4, 2011
On Thursday, March 31, 2011, the Centers for Medicare & Medicaid Services (CMS) provided the health care community with some much needed guidance by publishing its Proposed Rule regarding the Medicare Shared Savings Program and its Accountable Care Organizations (ACOs). -
The Future As Seen From the Anesthesia Administration Assembly Conference
March 28, 2011
To those readers who have not yet attended an AAA conference, we highly recommend that you place it on your agenda for 2012. -
What Should Anesthesiologists Know About the RACs?
March 21, 2011
In the 1990s, anesthesiologists feared the Department of Health and Human Services Office of the Inspector General (OIG) and at the same time were hard pressed to identify fellow physicians who had undergone an OIG audit. Something of the same phenomenon is occurring now with the Medicare Recovery Audit Contractor (RAC) program. We are more educated about compliance with the Medicare rules and about government audits. The RACs have not pursued many anesthesia practices, and their scope is more limited by law than that of CMS and the OIG. We know that as a matter of law the RACs have the power – and the financial incentive – to ruin a medical practice, but we haven’t heard that they are frequently going after overpayments to anesthesiologists. A review and an update, more than a year since the permanent RAC program was implemented, are in order. -
Getting Paid for Post-Anesthesia Visits
March 14, 2011
Some anesthesia groups are seeing a growing number of denials of claims for evaluation and management (E/M) services provided in the postoperative period. Specifically, some of these denials are based on a new policy that California’s Anthem Blue Cross implemented effective November 21, 2010, disallowing “postoperative E/M visits reported within a 10 day aftercare period for anesthesia services.” This policy appears much more restrictive than that of other payers. In effect, it would create a 10-day global period for anesthesia services, although Medicare and other payers do not recognize any such thing. -
When Patients Are Responsible for a Large Portion of Their Anesthesia Bill
March 7, 2011
In last week’s Alert, we wrote about billing patients who go out of network for the difference between the anesthesia practice’s fee and the amount allowed by the third party payer. More specifically, we explored some legislative and judicial efforts to insulate the patient from large unexpected bills when their insurer has not contracted with all of the providers whom the patient may see. The phenomenon we report here is different: even though there is no question about the patient’s liability for the payment, collecting the full amount can be difficult. -
Balance Billing Anesthesia Patients Who Go Out of Network
February 28, 2011
Illinois is the latest state to attempt to legislate a compromise between the respective interests of the patient, the provider and the health plan. In late November 2010, the Illinois legislature passed House Bill 5085 – which the Illinois Society of Anesthesiologists (ISA), and many others, promptly asked the Governor to veto. -
Did Medicare Underpay Your Anesthesia Practice in 2010?
February 21, 2011
There are not many anesthesiologists who will hesitate to answer “yes” to the question in the title. The first section of today’s Alert is not about the inadequacy of Medicare payment rates or the Sustainable Growth Rate (SGR) problem, though. Rather, CMS wants you to know that it will soon begin to reprocess millions of claims because of retroactive provisions in the Patient Protection and Affordable Care Act (PPACA) and retroactive adjustments to the Medicare Physician Fee Schedule. -
Three Significant Changes to the Interpretive Guidelines for Anesthesia Services
February 14, 2011
Around this time a year ago, our readers were struggling to understand and adapt to a newly-revised set of Interpretive Guidelines (IGs) for anesthesia departments. The IGs are part of the CMS State Operations Manual that gives hospital surveyors detailed instructions on ensuring that hospitals comply with the Medicare rules. Hospital compliance and hospital payment are Medicare Part A issues; Part B governs physician payment. Part A matters greatly to physicians, however, when it imposes obligations on hospitals that must be fulfilled by members of the medical staff. -
Constitutionality of Healthcare Reform; Significance for Anesthesiologists
February 7, 2011
To no one’s surprise, the United States Senate last week rejected a bill that would have repealed last year’s healthcare reform legislation, the Patient Protection and Affordable Care Act (PPACA). The vote proceeded along strict party lines, with all 51 Democrats present voting against the bill and all 47 Republicans voting in favor. It was, as the Washington Post said, “scripted political theater.” PPACA thus remains on the books, although it is widely anticipated that the new majority in the House of Representatives will try to starve it by withholding funding. -
Anesthesia and E&M Services and the RACs
January 31, 2011
In the Tax Relief and Health Care Act of 2006, Congress required a permanent and national Recovery Audit Contractor (RAC) program to be in place by January 1, 2010. The goal of the RAC Program is to identify improper payments made on claims of health care services provided to Medicare beneficiaries. -
Medicare Value-Based Purchasing Program for Hospitals: Anesthesia Departments Can Help
January 24, 2011
Hospitals are experiencing financial pressures at least as great as those of most anesthesia groups. Inflation-beating increases in Medicare payments are a thing of the past. (MedPAC, the advisory commission charged with making annual recommendations on the Medicare program to Congress, has called for a 1% increase in inpatient, outpatient and physician payments in 2012.) -
Reporting Fluoroscopy Together With Pain Injections—CPT Assistant Issues A Correction Notice
January 17, 2011
The November 2010 issue of CPT Assistant caused major consternation among pain physicians. In answer to a question regarding the reporting of fluoroscopic guidance, the publication stated that fluoroscopic guidance was bundled with the translaminar epidural injections, CPT 62310-62319, and was not separately payable.
