As we noted in our eAlert on the topic, the medical community's transition to the International Classification of Diseases and Related Health Problems 10th revision (ICD-10) has, contrary to expectations, gone fairly well so far. In fact, it has gone much better than anticipated, with rates of claims denials remaining essentially unchanged before a...

Summary The transition from paper-based anesthesia records to electronic anesthesia records has created new coding and billing challenges for anesthesia groups. Expanded clinical documentation requirements now require coders to access the preoperative note, intraoperative note, operative report and postoperative note. Problems with access to this i...

The rules pertaining to waivers of copays are certainly worth understanding. "It is an understatement to say the consequences of inappropriate waiver practices are significant," write returning authors Frank Carsonie, JD, and Nathan Sargent, JD, in their lead article for this Communiqué.In the current era of increased federal and state governmental...

SummaryThe changes in base unit values for anesthesia services for upper and lower endoscopy procedures for 2018, along with the replacement of two endoscopy codes with five more specific codes, were expected to have a negative financial impact on many anesthesia practices. An analysis of data for a representative sample of clients across the count...

One would think (or hope) that by the time anesthesiologists complete their training and begin practicing, they have mastered not only their clinical field, but also the ability to work well with others and behave appropriately. If you've spent any time as a member of an anesthesia group, however, you know that it is rare for all of the physicians ...

SummaryLegal cases presented at the Advanced Institute for Anesthesia Practice Management offer valuable reminders to anesthesia practitioners and pain specialists regarding the importance of documenting medical necessity for urine drug test screens, including quantitative tests, and compliance with the 60-day overpayments provision of the Affordab...

Roseanne M. Fischoff, MPP Economics and Practice Innovations Executive, American Society of Anesthesiologists•​ One regional medical center saved $1.5 million in the first year.•​ A Midwest academic center reduced average length of stay (LOS) for total joint replacement patients from 4.6 to 2.1 days.•​ A pediatric institution reduced the 30-day rea...

Summary Anesthesia and pain practices should stay abreast of risk areas not only nationally, but also locally, through their branch office of the U.S. Department of Justice, in order to help ensure compliance and protect their groups. We highlight two cases presented at the Advanced Institute for Anesthesia Practice Management by attorney Vick...

Howard Greenfield, MD Co-Founder and Principal, Enhance Healthcare Consulting, Aventura, FL Jody Locke, MA Vice President of Anesthesia and Pain Practice Management Services Anesthesia Business Consultants, LLC, Jackson, MI The steady migration of surgical cases from traditional inpatient to non-traditional outpatient and ambulatory venues has req...

Summary A growing body of evidence shows that implementing a perioperative surgical home (PSH) can yield important quality improvements, operational efficiencies and cost savings for hospitals, including reductions in length of stay and readmissions. However, many anesthesia groups have questions regarding the payment aspects of this model. On...

Anyone who has had to leave in the middle of a family dinner because of a call from labor and delivery or tried to sleep in the call room knowing that a recently completed case is bleeding and likely to come back that night probably also wonders whether they should be working somewhere with less call responsibility.Working on call is part of the re...

Summary The California Health Care Price Relief Act (AB 3087) proposes the creation of an appointed Commission that would "control in-state health care costs and set the amounts accepted as payment by health plans, hospitals, physicians, physician groups, and other health care providers." We offer an overview of the bill as a heads up to anest...

Mark F. Weiss, JD The Mark F. Weiss Law Firm, Dallas, TX, Los Angeles and Santa Barbara, CAThink back in time to a job interview. You dressed for success, put a wide smile on your face, and were on your best behavior.In the advertising world, they call them "reviews." In healthcare, we call them requests for proposal or "RFPs" for short. They're th...

Summary The second round of audits by the Office of Civil Rights of compliance with the Health Insurance Portability and Accountability Act (HIPAA) may be over, but HIPAA enforcement has not subsided. Anesthesia and pain groups, and their business associates, risk exposure to civil or criminal penalties if they don't comply with the administra...

"Most people will choose unhappiness over uncertainty. -Tim FerrisAnesthesia groups are facing great challenges in today's environment. I am sure you are aware of these various challenges so I won't belabor them.The question is: What do we do now?Some groups are throwing in the towel and selling out. It seems as though every few weeks another indep...

Summary We provide an overview of recently proposed legislation from the Senate Health, Education, Labor and Pensions Committee (HELP) and the Health Subcommittee of the House Energy and Commerce Committee to address the opioid crisis in the United States, including a large number of bills related to Medicare and Medicaid payment and coverage ...

Vicki Myckowiak, Esq. Principal, Myckowiak Associates, PC, Detroit, MIAnesthesia groups currently find themselves in the uncomfortable position of being a target of the Office of Inspector General (OIG) of the Department of Health and Human Services, the largest inspector general's office in the federal government, with approximately 1,600 people d...

Summary Changes to the Recovery Audit Program could be coming in 2018 that would lead to a less punitive, less burdensome and more educational and preventive approach by the government to identifying and correcting improper Medicare payments. Nonetheless, anesthesia practices are advised to be prepared for an audit. We offer recommendations to...

Summary Changes to the rules regarding opioid prescriptions through Medicare Part D for 2019 include a "hard edit" for opioid prescriptions at or above a cumulative daily equivalent of 90 milligrams of morphine; no more than a seven-day supply of opioid medication for opioid naïve patients; and restrictions on concurrent prescribing of opioids...

​SUMMARY Covered entities, including anesthesia practices, are required under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to execute a contract with business associates to safeguard the privacy and security of protected health information (PHI). As the holder of the PHI, anesthesia groups should make sure they under...