For all the time most anesthesiologists spend in the operating room and the Post-anesthesia Care Unit (PACU) there is a curious firewall when it comes to the Intensive Care Unit (ICU). Most anesthesia practices are actively pursuing ways to generate additional revenue and further strengthen their relationship to administration and yet rarely do such considerations include any discussion of the ICU. As a large national billing company with hundreds of clients across the country, we only bill for a few clients that cover the ICU. One might therefore ask, “Are these practices visionaries of a future reality or isolated exceptions?” What is the opportunity and what would be involved in exploring it? Why are the very physicians who promote themselves as ideal managers of the entire perioperative continuum not pursuing a more active role in the ICU? It would appear to be a logical and integral part of the Perioperative Surgical...

The “two-midnight rule” was established by the 2014 Medicare inpatient prospective payment rule.  According to the policy, inpatient admissions extending through at least two midnights generally qualify for Medicare Part A payments.  Surgical procedures, diagnostic tests and other services are presumptively appropriate for inpatient hospital admission and payment when (1) the physician “reasonably” expects the patient to require a stay that crosses at least two midnights and (2) admits the patient to the hospital based upon that expectation.  Inpatient stays lasting fewer than two midnights are considered and should be billed as outpatient or observation services under Medicare Part B.CMS introduced the policy to monitor Medicare reimbursement for short inpatient stays and to reduce the number of inpatient admissions deemed non-medically necessary.  Aggressive auditing by the Recovery Audit Contractors (the RACs) had recovered more than $2 billion a year from hospitals over the two fiscal years prior to June 2013, according...

Reimbursement pressures for anesthesia practices are continuing to escalate due to fluctuations in our healthcare environment. Safeguarding collections is critical and it has become more important than ever to collect every dollar without leaving anything on the table. Good clinical documentation supports accurate coding and the impending ICD-10 implementation increases that significance. For anesthesia providers to facilitate the reduction of coding errors, it is imperative that they have a sound understanding regarding the relationship between good clinical anesthesia documentation and accurate coding. Incomplete documentation requires a return visit to the provider or a review of the operative report which in turn delays the processing and payment of a claim. Delays in claims processing decreases revenue. Procedure Undercoding Lack of detail by the anesthesia provider concerning the procedure description is one of the top reasons for undercoding. Detail is vital for accurate coding and optimal reimbursement. Opening the lines of communication between...

One of our readers asked us recently what his group needed to report under the Physician Payments Sunshine Act.  The answer:  nothing.  The Sunshine Act, which is part of the Affordable Care Act, requires pharmaceutical and medical device manufacturers to report payments and other items of value worth more than $10, as well as certain ownership interests held by physicians and immediate family members.  (See our Alert of August 5, 2013, Drug Manufacturers’ Payments to Anesthesiologists Are Now Reportable under the Sunshine Act.)  It does not impose any tasks on physicians. Prudent physicians will want to take advantage of the option to verify the information that will be posted under their name in the Open Payments System before publication, though.  Time is running.  If you log on to the American Medical Association website (www.ama-assn.org), the first thing you will see is this message.   Detailed information about how to complete each part...

We recently had the opportunity to talk with one of our favorite surgeons about what she wants from her anesthesiologist or care team.  Some of the items on the list below will be very familiar—so much so that it’s surprising that the issue still comes up.  Others are specific to our surgeon’s specialty, otolaryngology, they may sensitize readers to analogous concerns affecting other specialties. Classic Bêtes Noires I would like fast turn-over times; my time is valuable. Anesthesiologists’ time is valuable too, and they like fast turn-overs as much as do the surgeons.  This is an area where performance metrics can be particularly helpful.  If turn-overs take longer than national or local benchmarks, there is a wealth of information on how a facility might improve (e.g., numerous publications by Franklin Dexter, MD, PhD including Economics of Reducing Turnover Times, 2014; Laura Dyrda, 8 Steps to Quicker Turnover Time in ASCs, Beckers...