Patients who go out of network can present serious collections problems for the physicians who do not participate in the network.   Managed care organizations (MCOs) often send the check to the patient in order to pressure physicians to sign participation agreements, leading to the necessity for practices to collect directly from the patients, something that is especially challenging for hospital-based anesthesiologists and other physicians who do not have ongoing relationships with their patients.MCOs do not like patients going out of network either, and increasingly some payers are going to extreme lengths to discourage that behavior. The efforts of one such payer, Aetna Health of California, Inc., to limit the use of out of network services recently led to the filing of a lawsuit.  On July 3, 2012, the California Medical Association (CMA), three county medical societies, and a coalition of four surgery centers and 60 physicians and one unidentified patient brought an...

Many, if not most, anesthesia practices provide services at ambulatory surgical centers (ASCs) as well as at hospitals.  Some 11 percent of anesthesiologists have invested in the ASC as part owners, according to Medscape’sAnesthesiology Compensation Report: 2011 Results.  Others invest their energy in contracts to staff ASCs.  In either case, it is important to know the economic condition and value of one’s ASC.One way to approach the matter is to analyze the attractiveness of the ASC to a buyer.  Buyers tend to invest in outpatient facilities with room for improvement in performance.  Whether you are considering buying (or selling) an ownership share or entering into or renewing an exclusive contract, the ASC’s appeal to a potential corporate investor such as an ASC management company is relevant.Becker’s ASC Review E-Weekly ran an article with “10 Questions to Evaluate ASC Investment Opportunities” in its June 16, 2012 issue.  Outpatient Surgery Magazine alerted subscribers to a 2009...

This issue of the Communiqué is a keeper. On pages 6 through 10 you will find tables that lay out clearly the Electronic Health Records (EHR) incentive program’s Stage 1 Meaningful Use objectives, the recently proposed changes to Stage 1, and the potential Stage 2 objectives, measures and exclusions as proposed by CMS in March. The objectives, translated into measures, are capabilities that your EHR must have in order for you to qualify for the incentive, which is non-negligible at a maximum of $44,000 per physician, or to avoid the penalty for non-compliance. Even though the proposed changes discussed in the Meaningful Use article by Abby Pendleton, Esq. and Stephanie Ottenweis, Esq. are likely to be different in some respects when CMS issues the final regulation later in the year, it is worth familiarizing yourself with the proposals because understanding the final versions will be that much easier.The Meaningful Use article,...

A change to some language in the Anesthesia Services chapter of the Medicare National Correct Coding Initiative (NCCI) manual recently created considerable confusion among participants in the on-line discussion maintained by the Medical Group Management Association (MGMA) for the Anesthesia Administration Assembly (AAA).The information that gave rise to the confusion has been clarified.  The NCCI has confirmed that there has been no policy change here; epidurals and blocks placed preoperatively for the management of postoperative pain are still separately reportable and not bundled into the anesthesia service unless they are used as the method of administering the anesthesia itself. Because the issue of post-op pain management is a perennial hot topic, we take this opportunity to help ensure that no incorrect interpretations take root.Chapter II of the NCCI manual, “Anesthesia Services,” was revised effective January 1, 2012.  It contains a number of statements that are consistent with the established principles of billing...

The most significant change for anesthesia and pain medicine practices in the proposed Medicare Fee Schedule rule for 2013 (NPRM), released on July 6, 2012, was the proposal to allow nurse anesthetists to perform chronic pain services without physician supervision in those states that include such services in the scope of practice of nurse anesthesia.  As noted in last week’s Alert, the 765-page NPRM contains many other potential changes.  Highlights appear below.1. Medicare Payment Rates in 2013It comes as no surprise that the 27 percent cut mandated by the Sustainable Growth Rate (SGR) formula remains in place for now and will take effect on January 1, 2013, if Congress fails to act.  Fear of the economic cliff that the entire country faces with mandatory spending reductions and the expiration of tax cuts early next year will undoubtedly affect how Congress deals with the SGR for 2013; what we cannot predict now...