2013 OIG Work Plan Now Includes Anesthesia
Anesthesia Services -Payments for Personally Performed Services (New)
“We will review Medicare Part B claims for personally performed anesthesia services to determine whether they were supported in accordance with Medicare requirements. We will also determine whether Medicare payments for anesthesiologist services reported on a claim with the “AA” service code modifier met Medicare requirements. Physicians report the appropriate anesthesia modifier to denote whether the service was personally performed or medically directed. (CMS’s Medicare Claims Processing Manual, Pub. No. 100-04, ch.12, @ 50) The service code “AA” modifier is used for anesthesia services personally performed by an anesthesiologist, and the “QK” modifier is used for medical direction of two, three, or four concurrent anesthesia procedures by an anesthesiologist. The QK modifier limits payment at 50 percent of the Medicare-allowed amount for personally performed services claimed with the AA modifier. Payments to any service provider are precluded unless the provider has furnished the information necessary to determine the amounts due. (Social Security Act, @1833(e).)”
(OAS; W-00-13-35706; various reviews; expected issue date: FY 2013; new start)
Resource: OIG 2013 Work Plan
Survey Shows Physicians Limiting Practice Access for Medicare and Medicaid Patients
More than 50 percent of physicians have limited access to their practice for Medicare patients or are planning to do so in the future according to a recent survey commissioned by the Physicians Foundation. In addition, 26 percent of survey respondents have stopped seeing additional Medicaid patients at this time. Physicians cite rising operating costs, time constraints, and diminishing reimbursement as the primary reasons for not accepting additional Medicare and Medicaid patients.
The survey also indicates that physician morale is low with more than 75 percent of respondents being pessimistic about the future of the medical profession. Physicians are not uniform in their opinions, with younger, female, employed, and primary care physicians being generally more positive about the profession.
The survey, conducted this spring by Merritt Hawkins via email, was sent to more than 600,000 physicians across the United States with 13,575 responding.
