Archive for the ‘Anesthesia Billing’ Category

Anesthesiologists Campaign Against Nurse Pain Payments

06 Sep

Last month, The American Society of Anesthesiologists (ASA) launched a nationwide campaign opposing the Centers for Medicare and Medicaid Services’ (CMS) proposal to pay nurse anesthetists for chronic pain service. The crux of the opposition is that nurse anesthetists are not equipped with the necessary formal education or training in chronic pain management.

“Even in the hands of specially trained physicians, chronic pain procedures are inherently dangerous due to the anatomy and delicate structure of the spine and nerves upon which chronic pain interventions are performed,” said ASA President Jerry A. Cohen, M.D. “Current restrictions on nurse anesthetists providing these services are appropriate and necessary in the interest of patient safety.”

In addition to the health risks, the ASA says there is also the risk of extensive and costly medical interventions. They argue the point that anesthesiologists and other doctors are better equipped to provide pain management care and minimize these risks due to their education and training, and are able to prescribe appropriate medication therapies in the process. 

Chronic pain services will often include opioids, where specialized physician training is required to minimize errors and prevent potentially lethal side effects.

“Using scarce Medicare dollars to pay nurse anesthetists to perform complicated pain service procedures unnecessarily puts patients at risk,” says Cohen. “Patients who require anesthesia or relief from pain deserve the safest and highest quality of care.”


Regulation to Change on Reporting Anesthesia Time

05 Sep

There is a transition underway to the 5010 HIPAA electronic claims standards. The American Society of Anesthesiologists has announces that, as part of this transition, there will be a universal system for reporting anesthesia time to all payers which will go into effect January 1, 2012. This new standard will require all anesthesia time to be reported in minutes instead of units. While some payers already use this system currently, by January, 2012 it will be a requirement for all payers.

The ASA has spent years successfully lobbying against this change, but change is on the way. Part of the resistance was due to the fact that the change can cause some payers to move from a full unit to fractional unit payment system. While this may benefit some anesthesia providers it may also cost some providers money, depending on when individual contracts permit rounding to the next unit. According to the report, the change will not stop contracts from rounding to the nearest whole unit when determining payments.

Changes to commercial payment contracts will have to be negotiated between anesthesiologists and commercial providers. Anesthesiologists should be aware of this change when negotiating contracts with payers.


What are the Costs vs Benefits to the ICD-10?

23 Nov

The most recent medical coding, or International Classification of Diseases, is ICD-10. It was endorsed by the 43rd World Health Assembly in May 1990 and was started to be used in WHO Member States in 1994. But it’s not until 2013 that we will see these revisions in the U.S.

So, how does the ICD-10 differ from the ICD-9 set of codes currently in use in the U.S.? The ICD-10-CM codes are very different. All codes in ICD-10-CM are alpha-numeric. There can be as many as seven alpha-numeric characters. This means that billing software programs must be changed to accommodate the additional digits. This also means more extensive medical billing coder training.

While there won’t be much change in how the physician does his or her documentation in the medical records, the translation process into ICD coding will change. The newer codes will provide more detailed information about the patient’s condition.

It’s interesting to see some of the data comparing what ICD-10 will cost versus what it can save hospitals and healthcare providers. The RAND Science and Technology Policy Institute did a cost/benefit analysis of implementing ICD-10. What they found was that providers will incur costs for computer reprogramming, training coders, physicians, and code users, and for the initial and long-term loss of productivity among coders and physicians.

The cost of sequential conversion (10-CM then 10-PCS) is estimated to be between $425 million and $1.15 billion in one-time costs. There will also be between $5 and $40 million lost in yearly productivity.

But there are benefits as well, many benefits that RAND sees coming from the new detail provided in ICD-10. And, as you will see, they far outweigh the costs.

– More accurate payments to hospitals for new procedures is believed to save $100 million to $1.2 billion.

– There are also benefits from fewer rejected claims, which may be $200 million to $2.5 billion.

– But wait there’s more… in the form of $100 million to $1 billion in fewer exaggerated claims.

– The identification of more cost-effective services and direction of care to specific populations would result in $100 million to $1.5 billion.

– There are also untold benefits that would come from better disease management and better directed preventive care.

In light of these enormous changes coming into effect many anesthesiologists are even more likely to benefit from outsourcing their billing to a medical billing company that specializes in providing anesthesia billing services.


Billing Codes Increase in 2013, Threaten to Slow Billing Process

25 Oct

According to the New England Journal of Medicine, overhead and billing expenses take up as much as 43 percent of a doctor’s annual revenue. When you consider the fact that insurance companies will not always make it easy on you to have your claims paid, it makes it that more daunting. But, when 2013 rolls around, the challenge gets tougher. In fact, you will have 155,000 reasons to consider hiring a medical billing company to handle your claims.

Published by the World Health Organization (WHO), The International Statistical Classification of Diseases and Related Health Problems (ICD-9) currently contains 17,000 billing codes to choose from in order to classify diseases and a wide variety of symptoms, causes, and other variables. But, all that will change on October 1, 2013, when the number of codes will increase to an astounding 155,000 under the ICD-10.

As one might suspect, more codes means longer billing processes. Coders will need to increase their knowledge of anatomy, physiology, and medical terminology. They will also need to work more closely with doctors to work out the kinks in the new coding process.

The United States is late to the game, so to speak, with implementing the ICD-10. Other countries that have been under the latest coding guidelines for years have reported significantly longer turnaround time on their accounts receivable.

But if the transition is handled effectively, those bumps in the road should be short-term. If nothing else, the pending coding changes underscores the value of outsourcing your medical billing needs to a medical practice management company.


Hiring a Medical Billing Company Increases Profits

19 Oct

There are many reasons for Anesthesiologists, or any other medical practice, to hire a medical billing company. If you are considering a medical billing service for your practice, there are several types (or sizes) of companies to choose from. There are large national firms and small local medical billing companies that may be able to give you a little more of a personalized service. There are even offshore companies that perform medical billing services.

But, the most important thing to know about potentially hiring a medical billing service is, how does it benefit your medical practice? There are many, but possibly the most important is that it will increase your bottom line.

One of the misconceptions of hiring a medical billing company is that it will become an expense. In reality, a quality medical billing service will not only pay for itself, it will increase your profits. If you are performing your billing in-house, when you add the expenses related to hiring a billing staff, hardware and software, and IT support, the costs will often exceed the medical billing company’s fees.

Anesthesiologists in particular can benefit by outsourcing anesthesia billing, as most anesthesiologists spend the majority of their time in a hospital setting separated from the billing and operations side of their business. Hiring a medical billing company that understands the billing & coding processes for anesthesia can greatly increase profit and patient care.

If you outsource your medical billing processes to a company that knows its business intimately, they will find ways to eliminate hidden costs. Your medical practice splits its time and resources between patient care and the billing process, whereas a medical billing company concentrates their entire effort on handling your billing. They can do it more efficiently, which brings costs down and profits up.