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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4.76 Percent Increase in Medicare Anesthesia Conversion Factor For 2009
October 31, 2008
The Medicare conversion factor (CF) for anesthesia services will increase by nearly 5 percent to $20.92 on January 1, 2009. The Centers for Medicare and Medicaid Services (CMS) announced the update on October 30, 2008 in its “Final Rule” on the Physician Fee Schedule for 2009.
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The RAC Program Is a Headache For Medicare, Too
November 10, 2008
Medicare Recovery Audit Contractors (RACs) are private companies that review Medicare professional and facility claims and are paid a contingency fee for any overpayments (and yes, underpayments) they can identify. Anesthesiology and other physician practices have been nervously contemplating the potential threat of the (RAC) program in at least the six states where CMS has conducted a demonstration project over the last few years.
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Ultrasound and Place of Service are Targets of Interest in the 2009 OIG Work Plan
November 17, 2008
The number of ultrasound services—including the use of ultrasound guidance for peripheral nerve blocks—billed to Medicare and other payers continues to grow rapidly.
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New Medicare ABN Form Will Become Mandatory
November 24, 2008
Medicare allows physicians and other providers to collect fees from patients for services that are not covered by the Medicare program if they have alerted the patients of their potential liability using an "Advance Beneficiary Notice" (ABN).
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More On "Never Events"
December 8, 2008
Three more “never events” – adverse events that should ideally never happen to inpatients – for which Medicare recently proposed to hold hospitals financially responsible are:
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How Much Do You Know About "Never Events"?
December 1, 2008
Run a Google search on “never events” + hospital + Medicare and you will find about 15,700 results. Among the most recent are articles on the new Medicare regulations that limit-payments to hospitals for treating patients for events that should never have occurred – the Hospital Acquired Conditions (HAC) regulations.
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Anesthesiology Leaders Look at the Speciality TenYears Down the Road
December 15, 2008
Greetings from New York City, where we are updating our knowledge and renewing our relationships at the 62nd annual PostGraduate Assembly in Anesthesiology, sponsored by the New York State Society of Anesthesiologists.
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How to Report TEE for Monitoring
January 12, 2009
Our Compliance department recently fielded a question regarding the appropriate coding for intraoperative transesophageal echocardiographic (TEE) monitoring. The question, specifically, was whether it would be appropriate to report the placement of a TEE probe with CPT™ code 93313 for monitoring purposes. The answer is no, as confirmed in correspondence with the AMA CPT Education and Information Services.
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PQRI 2009
January 5, 2009
The New Year has brought several important changes to the Medicare Physician Quality Reporting Initiative. Whether you participated in the PQRI in 2008 and plan to continue or whether you are ready to begin reporting the PQRI measures in 2009, we would like to summarize the changes for you.
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Pain Medicine and the PQRI
January 12, 2009
This year, as in 2007 and 2008, the Physician Quality Reporting Initiative does not contain any measures designed specifically for the subspecialty of pain medicine. Although the total number of PQRI measures has increased to 153, quite a few subspecialties are not yet represented.
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Safety and Crisis in Aviation and in Anesthesiology Practice
January 20, 2009
Like everyone who followed the story of the Miracle on the Hudson, the emergency water landing of US Airways Flight 1549 on January 15, we were grateful for the survival of all 155 persons aboard. We were awestruck by the skills of the pilot, Captain Chesley B. Sullenberger III and profoundly impressed by the coordination and efficiency of the crew and of the rescue efforts.
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Anesthesiologists' Hospital Relationships in the 2009 Recession
January 26, 2009
Anesthesiologists’ relationships with their hospitals were the focus of several excellent presentations at this year’s ASA Practice Management Conference, from which we have just returned. Contracting with hospitals, perennially a hot topic, is commanding even greater attention in this time of economic contraction. ABC Vice Presidents Jody Locke, Craig Van Valkenburg, Jackie Popiela and Karin Bierstein covered numerous sessions and hope to extend some of what they learned to those of you who were unable to attend the Conference.
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Electronic Medical Records in Anesthesia 2.2.09
February 2, 2009
President Obama’s $819 billion Economic Stimulus package calls for a $20 billion investment in health information technology. Approved 248-188 by the House of Representatives on January 28, the American Recovery and Reinvestment Act of 2009 (H.R. 1) awaits adoption of the corresponding bill in the Senate. On January 27, both the Senate Finance and the Senate Appropriations Committees approved provisions within their respective jurisdictions. The Finance Committee proposed an estimated $17.9 billion for investing in HIT. The Appropriations Committee’s measure would provide $5 billion for incentives to adopt electronic health records.
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Special Alert
January 27, 2009
Anesthesiologist Tom George, MD has just announced that he is planning to run for Governor of Michigan. He is asking for thoughts, ideas and suggestions and we encourage you to contact and support him.
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New Blues Contract Reward Quality
February 9, 2009
We all continue to watch for the opportunity to negotiate the first payer contract that will reward anesthesiologists for “quality.” As we know so well, anesthesiology is already a 5.5 sigma specialty, and it accounts for only around 3% of spending on physician services. Payers do not yet perceive the same business case for incentivizing performance improvement in anesthesiology or even in perioperative care that they see in primary care.
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Anesthesia Top 10 Must Know For 2009
February 16, 2009
This week we are sending you an Alert that is longer than the usual e-mail you receive from us each Monday. 2009 promises to be a year with many changes in regulations, anesthesia coding and even legislation affecting our practices, and we hope that we are providing you with a valuable service by summarizing the top 10 – at least this week’s top 10 – below.
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Anesthesia Practice Developments Regarding Stark and Anti-kickback 2.23.09
February 23, 2009
A recent Federal appeals court decision just paved way for a qui tam whistleblower to proceed with a False Claims Act (“FCA”) case involving allegations of Stark and Anti-kickback Statute violations relative to an exclusive anesthesia coverage agreement and pain management services arrangement between an anesthesia group and a hospital. This case is noteworthy in many respects, and highlights how courts and enforcement officials may apply Stark to common anesthesia and pain management arrangements in the healthcare industry.
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The 2009 Stimulus Bill HIPAA Changes Impacting Anesthesia 3.2.09
March 2, 2009
HIPAA Privacy and Security Expanded by the Stimulus Bill: The Health Information Technology for Economic and Clinical Health Act (“HITECH Act” or the “Act”) included in the “Stimulus Bill” significantly expands HIPAA privacy and security provisions. These provisions will impact anesthesia and pain practices and many other entities in the health care industry.
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The UCR Reimbursement System is Code Blue 3.9.09
March 9, 2009
As we have long known, “UCR” rates on which health plans base their payments to nonparticipating physicians are not usual, customary or reasonable. A year-long investigation into the out-of-network payments by the Attorney General of the State of New York, Andrew M. Cuomo, resulted in a ground-breaking report entitled “THE CONSUMER REIMBURSEMENT SYSTEM IS CODE BLUE,” released on January 13, 2009. The report concluded that UnitedHealth Group had manipulated and used its Ingenix database of “prevailing” provider charges systematically to under-reimburse consumers (and their physicians).
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Should Anesthesia Run the OR?
March 18, 2009
The answer to the question “Should Anesthesia Run the Operating Room?” is: IT DEPENDS. Both “running the OR” and “Anesthesia” need to be defined. If “Anesthesia” means an anesthesiologist with the requisite leadership and organizational skills, patient safety and OR management knowledge and inclination toward systems- thinking, then yes, that individual would obviously have a significant contribution to make to the success of an OR.
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FTCs "Red Flag Rules" - Enforcement Begins May 1st
March 30, 2009
The May 1, 2009 enforcement date for what are commonly referred to as the “Red Flag Rules” is fast approaching. Many readers will remember that ABC addressed this topic in an e-blast last October, and also in February in our list of important issues for 2009. We are providing this additional information to assist you in your understanding of the regulations as they would apply to an anesthesia practice.
