Creative Documentation by Anesthesiologists May Lead to Medical Board Disciplinary Action

It’s hard to read much on the subject of anesthesia practice management without coming across the phrase “fraud and abuse.” Practitioners of this specialty have been thoroughly indoctrinated in the perils of inadequately or improperly documenting their services. More

Anesthesiologist-Hospital Arrangements and the OIG’s Increasing Scrutiny

While hospitals’ efforts to align themselves more closely with physician practices have been increasing, so has the attention of the Office of the Inspector General (OIG) of the Department of Health and Human Services. Relationships between physicians and facilities offer numerous, More

PQRI 0.5% Bonus for Maintenance of Certification in Anesthesiology

The national average anesthesia conversion factor (CF) for June 1st through November 30th is $21.5696. The highest local area CFs are to be found in Alaska ($30.15), Miami ($24.96), Detroit $(23.65) and Chicago ($23.60) and the New York City suburbs ($23.49). More

Proposed Rule for 2011 Physician Fee Schedule

CMS has released the 1250-page proposed rule containing changes to the Medicare Physician Fee Schedule for 2011. Chief among these changes is the calculation of next year’s conversion factor.... More

Last Call for Anesthesiologists to Report PQRI Measures in 2010

If you have not begun reporting Physician Quality Reporting Initiative (PQRI) measures on your claims to Medicare, you will have a second and final opportunity starting this Thursday, July 1. You can qualify for the 2% bonus incentive payment on your Medicare allowables... More

Anesthesiologists to Medicare and Private Payers: Show Me the Money

No, you haven’t already read this Alert stating that the 21.3 percent Medicare physician payment cut is now in effect. Yet again Congress has failed to pass legislation preventing us from going over the cliff. Late on Friday the Senate finally passed its version of the House-approved postponement of the SGR reduction in payments to physicians – too late More

Medicare Continues to Hold Your June Claims - Congress Expected to Take Action

CMS has announced that it will extend the current hold on claims for services performed on or after June 1st through June 17th so that Congress can complete action on the SGR fix. This follows on President Obama’s plea that the Senate pass legislation that would block the 21.3% cut in Medicare payments to physicians during his weekly presidential address last Saturday. More

Anesthesia Employment Contracts and Fee-Splitting

“Dr. P.,” an anesthesiologist, was hired as the medical director of a for-profit ambulatory surgery center, “ASC-D.” Dr. P. and the other members of the anesthesiology department were to provide anesthesia services at ASC-D and at a number of off-site private physicians' offices. Dr. P.’s employment contract required him to turn over all fees earned from anesthesia services, including cases performed off the ASC’s premises. Under the contract, Dr. P., like other anesthesiologists employed by the ASC, was to receive a share of those fees back in the form of distributions from the annual “Net Anesthesia Revenue Pool” in addition to his base salary. More

Another Reason for Anesthesiologists to Resist Medicare Linkages in Their Private Payer Contracts

You already know that basing private health plan payment rates on the Medicare Fee Schedule would bankrupt your practice. We do not know of any anesthesia practice that has ever been forced to accept 100% of the Medicare conversion factor, but there are some groups that have agreed to 150% or other multiples of Medicare. More

Four Important Medicare Updates for Anesthesiologists

Today, June 1st, is the date that the 21.2 percent un- Sustainable Growth Rate (SGR) reduction in Medicare payments to physicians is going to go into effect. Once again Congress is trying to pass legislation that will give physicians a very small increase for now and defer solving the SGR problem until a later date – 2014, under the American Jobs and Closing Tax Loopholes Act of 2010 (H.R. 4213). The Senate adjourned without taking up the bill, however; it will return on June 7th. More

$10 Million Cost of Terminating an Anesthesiologist - Lessons Learned

Pinnacle Anesthesia Consultants of Dallas, TX terminated shareholder Neal Fisher, MD in a manner that cost the group more than $10 million by the time the state court appeal was over. More

Compliance – The Issue That Just Won’t Go Away for Anesthesia Practices

Anesthesia groups should review their compliance programs in light of the emphasis on combating fraud and abuse in the Patient Protection and Affordable Care Act (PPACA). While physicians account for a very small part of the billions of dollars paid out erroneously each year, the risks of flunking an audit and being faced with overpayment or fraud liability outweigh the hassle of compliance for most practices. More

Special Alert Tell Washington to Use the Health Care Reform Law to Review the Anesthesia Conversion Factor

Four key members of the U.S. House of Representatives are seeking support from their colleagues for a letter to the Department of Health and Human Services requesting a review of the accuracy of Medicare's payments for anesthesia services More

New Requirements for Documenting Pre-, Intra- and Post-Anesthesia Evaluations

Many anesthesiologists are uncertain how the Revised Anesthesia Services Interpretive Guidelines issued by the Centers for Medicare and Medicaid Services (CMS) in December 2009 changed documentation requirements. More

The Other Big Medicare Payment Problem – The Low, Low Anesthesia Conversion Factor

Medicare pays about 33 percent of average commercial payments for anesthesia services. This fact, well known to anesthesiologists, was one of the findings in a report published by the Government Accountability Office in 2007. The GAO study was based on a representative sample of anesthesia services performed in 41 Medicare payment localities. Other specialties, including pain medicine, collect an average of 80 percent or more of their commercial rates for Medicare patients. More

Electronic Health Records – HITECH Act Incentives For Pain Physicians

The Health Information Technology for Economic and Clinical Health Act (HITECH) provisions of the 2009 Recovery Act establish financial incentives starting in 2011 for “eligible professionals” (EPs) who are meaningful users of certified electronic health record (EHR) technology. EPs who qualify may receive up to $44,000 over 5 years, beginning in 2011.More

When should Anesthesiologists Bill the Consultation Codes?

As of January 1, 2010, Medicare stopped accepting claims for consultation services (CPT® codes 99241– 99245 and 99251–99255). Instead, physicians are to report the appropriate evaluation and management (E&M) codes:

• 99201-99205 (New Office/Outpatient Visit)
• 99211-99215 (Established Office/Outpatient Visit)
• 99221-99223 (Initial Hospital Care)(inpatient)
• 99231-99233 (Subsequent Hospital Care)

CMS claimed that the change was budget neutral in that the total relative value units assigned to the consultation codes were redistributed among the E&M codes. Many anesthesiologists and other physicians are finding, however...More

RAC Rules: HITECH Act Electronic Health Record Incentive Program- Bonus or Penalty for Anesthesiologists?

Most physicians have heard that they are going to be eligible for a federal payment of up to $44,000 between 2011 and 2015 if they use an electronic health record (EHR). Anesthesiologists continue to wonder, however, whether they will qualify for the bonus, since they rarely invest directly in EHRs or electronic anesthesia records, relying more typically on the hospital’s information technology (IT).

They will not qualify, in all likelihood. First, anesthesiologists do not use ...More

RAC Rules: Pre- and Post-Op Visits No Longer Bundled With Anesthesia Services

Before a Medicare Recovery Audit Contractor (RAC) may send a demand letter or a request for records to a provider, an improper payment “issue” must first be approved and be posted on the RAC’s website. In January of this year, one of the first CMS-approved issues relating to anesthesia appeared on Health Data Insight’s website. HDI is the RAC for Region D, which encompasses...More

What Does the Health Care Reform Legislation Mean for Anesthesia Practices?

On Friday afternoon, March 26th, the Senate adjourned for the “Spring District Work Recess” without adopting legislation that would have extended current Medicare physician payment rates through April 30, 2009.  A vote on extending those rates is scheduled for the afternoon of April 12th, the day that the Senate returns.   Readers should make sure to contact their Senators once again to...More

The Anesthesia Quality Institute is Open for Business!

ABC encourages all readers of our Alerts to familiarize themselves with the Anesthesia Quality Institute, established by the American Society of Anesthesiologists last year and now enrolling practices that wish to compare their clinical and business management performance data to national benchmarks.

We believe that the AQI and its database, the National Anesthesia Clinical Outcomes Registry, will become vitally important to ...More