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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Anesthesia and Related Targets in the 2010 O.I.G. Work Plan
November 2, 2009
The Department of Health and Human Services’ Office of the Inspector General (OIG) Work Plan for fiscal year 2010 contains one item of specific interest to anesthesiologists and pain physicians who perform transforaminal epidural injections. The OIG intends to review Medicare claims for these procedures to determine the “appropriateness” of payments made. This means that documentation, including the medical record, must demonstrate that the injection was “reasonable and necessary.”
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Anesthesiologists’ PQRI Reports – Here We Go Again
October 26, 2009
Anesthesia practices that successfully participated in the Physician Quality Reporting Initiative (PQRI) in 2008 have begun receiving notices of payment from Medicare. Some practice administrators are wondering why the PQRI bonuses were lower than anticipated. Others are “pleasantly surprised” because they expected Medicare not to come through at all.
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Healthcare Reform: A Satisfying Week for Anesthesiologists October 19, 2009
October 19, 2009
On Sunday, October 11, the health insurers’ lobby turned on the Obama Administration by releasing a report showing that health care premiums for a typical family would grow by $1,000 to $4,000 per year under the Senate Finance Committee’s Healthcare Reform (HCR) package. On Tuesday, the Finance Committee passed its HCR bill, “America’s Healthy Future Act,” 14-9, with one Republican joining the majority. On Wednesday, Democratic leaders threatened to revoke the insurers’ antitrust exemption, a threat echoed by the Speaker of the House of Representatives on Thursday. Senate Democrats also met with representatives of organized medicine and introduced legislation that would repeal the Sustainable Growth Rate (SGR) formula and avert a projected 40 percent decrease in Medicare payments to physicians over the next five years.
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Taxing Anesthesiologists and Others to Pay for Expanded Health Insurance Coverage
October 12, 2009
While Congress looks at surtaxes on high-income individuals and at taxes on “Cadillac” health plans as a means to help pay for healthcare coverage for the uninsured and underinsured, a number of States have already implemented or considered “provider taxes.
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ABC Sponsors A Celebration of Advocacy
October 5, 2009
ABC is very proud to be the sole sponsor of ASA’s Celebration of Advocacy, a major inaugural event that will take place on Saturday, October 17, 2009 from 11:30 a.m. to 1:00 pm at the Ernest N. Morial Convention Center in New Orleans.
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Anesthesiologists’ Hospital Stipends: Exceed “Fair Market Value” at Your Stark Peril
September 28, 2009
On August 25, 2009, Covenant Medical Center (“Covenant”) in Waterloo, Iowa agreed to pay the United States $4.5 million to resolve allegations that it violated the False Claims Act. Specifically, the U.S. government alleged that Covenant’s compensation to five employed physician specialists violated the federal Stark law and therefore also violated the False Claims Act with respect to related Medicare claims. The case highlights the importance of hospitals and employed physicians having their compensation arrangements reviewed for compliance with the federal Stark law.
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FAQs on RACs for Anesthesiologists
September 21, 2009
If you have not yet discovered the Frequently Asked Questions (FAQs) feature of the Centers for Medicare and Medicaid website (www.cms.hhs.gov), you are overlooking an increasingly valuable tool. As of September 18, 2009, when the three most recent answers were posted, there were 1917 questions and answers ranging from the most basic “What is CMS?” to the quite esoteric. Entering a search term like “PQRI” or “EHR” will bring up a list of 88 or 58 questions respectively.
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What Anesthesia Practices Should Know About Medicare Local Coverage Determinations and “Articles”
September 14, 2009
This week we would like to elaborate on the content and importance of the articles and policies published by the Part B (physician services) Medicare Administrative Contractors (MACs), formerly known as your local Medicare carriers.
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Swan-Ganz Values Increase; HITECH Act Regulations Tighten Up HIPAA Privacy and Security Requirements
September 8, 2009
The Stimulus Package adopted in Washington last spring, the American Recovery and Reinvestment Act of 2009, included legislation known as the HITECH Act...
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Dear CMS: ASA Presents its Views on the 2010 Medicare Fee Schedule
August 31, 2009
Today is the deadline to file “comment” letters with CMS regarding the proposed Medicare Physician Fee Schedule for the calendar year 2010. The American Society of Anesthesiologists has made numerous points in its comment letter to the Centers for Medicare and Medicaid Services (CMS).
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Where Do Payer Policies on Medical Necessity Come From?
August 24, 2009
You wonder whether your patient’s insurance will cover monitored anesthesia care (MAC) for an upper GI endoscopy, or for a pain medicine procedure. For that matter, how many pain injections will the payer cover? You have heard that many anesthesiologists are successfully billing for the pre-operative history and physical and you would like to know whether they know something that you don’t.
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Why Are The Payers and Policymakers So Sure That Physicians Are Overcharging?
August 17, 2009
As Congress finally left Washington, D.C. for the August recess, it was clear that the cost of universal coverage was becoming the dominant challenge in healthcare reform. We may not be able to afford healthcare for all – according to one recent estimate, spending on health services will grow to 20 percent of GDP as early as 2017, and to 100 percent before the end of the century – but we also may not be able to afford a continuation of current levels of spending.
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The RACS (Recovery Audit Contractors) Begin to Show Their Stuff
August 10, 2009
Do you remember the systems meltdown we were all told to expect when our computer clocks rolled over to 01/01/2000 – the Y2K issue? Anesthesia practices and other businesses listened to the doomsday warnings, invested resources in preparing their information systems for the end of the 20th century, and proceeded smoothly into the year 2000. Excellent preparations had headed off most problems. ABC and other consultants are hoping that by educating you on avoiding and surviving a “RAC attack,” the arrival of the Medicare Recovery Audit Contractors will provide as little drama as did your software when 1999 rolled over.
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Pain Medicine Is Still in Medicare’s Fraud-and-Abuse Viewfinder
August 3, 2009
A number of pain medicine practices have recently found themselves targeted for audits by Medicare contractors. Audit letters from contractors including NGS and WPS have focused on medical necessity issues in connection with nerve blocks, epidural injections and other services administered in private office settings for chronic pain management. This activity serves to remind us all of the importance of documenting medical necessity for interventional pain procedures.
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Medical Direction Documentation Choose a Documentation Method That Works Best for You
July 27, 2009
Fortunately or unfortunately, depending on your perspective, CMS has not provided specific instruction on exactly how this documentation must be accomplished.
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What Happened Late Last Week in Healthcare Reform?
July 20, 2009
Right now the healthcare reform (HCR) comet is moving so fast that the best use of these Monday Alerts is to keep you abreast of major developments affecting anesthesia practice. On Wednesday July 15, we sent you a special Announcement shortly after the House of Representatives “Tri-Committee” (Committees on Ways and Means, Energy and Commerce, and Education and Labor) released its $1 trillion-plus, 1000-page bill, “America’s Affordable Choices Act” (H.R. 3200).
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Epidurals and Blocks Are Still Separately Payable – How to Handle Medicare Denials Based on CCI Bundling Edits
July 13, 2009
You may have started receiving unexpected denials from Medicare for epidural injections and nerve blocks performed together with a number of invasive monitoring line insertions and injection/aspiration procedures. THESE DENIALS MAY BE WRONG, according to a response received by the American Society of Anesthesiologists (ASA) questioning the change that “bundled” the procedures.
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Proposed Changes to the Medicare Physician Fee Schedule for 2010
July 6, 2009
The Centers for Medicare and Medicaid Services (CMS) published the “proposed rule” for the 2010 Physician Fee Schedule on Wednesday July 1st. CMS will receive written “comments” on the proposed changes through August 31, 2009 and then issue the final rule in November. This Alert will summarize the proposals of greatest interest to anesthesiologists and pain medicine specialists. Much of what follows will be of interest to nurse anesthesia practices as well.
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A Brief Refresher Course on the National Practitioner Data Bank
June 29, 2009
The numbers of anesthesiologists reported to the National Practitioner Data Bank (NPDB), which was created by the Health Care Quality Improvement Act of 1986 (HCQIA), continue to be very low.
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Will the Federal Stimulus Package Help Pay for your Anesthesia Practice's Health Information Technology?
May 18, 2009
Beginning in 2011, eligible professionals may apply to receive Medicare “incentive payments” for the meaningful use of a certified Electronic Health Record (EHR) system. EHR systems include an electronic record of health-related information on an individual patient that contains demographic and clinical health information and has the capacity to provide clinical decision support, support physician order entry, capture and query information relevant to healthcare quality, and exchange electronic health information with, and integrate such information from, other sources.
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Your Other Hospital Contracts The Medical Staff Bylaws
May 11, 2009
One half or more of all anesthesia groups have service contracts with hospitals and/or ambulatory surgical centers. The majority of anesthesiologists who have hospital privileges have another very important contract with their facilities: the medical staff bylaws.
