The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule.  HHS will announce a new compliance date moving forward.

 ”ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius.  “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead.  We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

1. Figure out where your cases will be most profitable. Pain management physicians should analyze their cases to determine the most profitable place of service (POS) for each procedure they perform. Not all cases pay well in all locations. Schedule cases in the location that pays best.

2. Keep implants in mind when negotiating payer contracts. Some pain procedures require expensive implants and if payer contracts don’t reflect a competitive rate, you won’t make money on those procedures. Carve-out the procedures that include an implant to ensure better rates within the contract.

3. Have expert coders for pain management. Pain management professionals utilize a lot of new innovations and procedures. Physicians should be aware of which procedures an insurance company considers experimental to avoid denied claims and loss revenue. Coders must stay current with the latest technology and procedures to optimize the reimbursement for the pain practice.  

4. Be prepared for denied claims. Billing staff and coders should know how to handle denied claims. Claims are denied for a multitude of reasons and coders may need to refer back to the physician for clarification. If a procedure is performed differently than usual, the coder must know the reasoning behind this change to support reimbursement from the payer. Accurate clinical documentation will always provide support to your staff when appealing denied claims.

5. Train staff in patient collections. Your staff must be trained in the art of persuasion. This might mean asking the patient which type of credit card they’d like to pay with instead of asking how they would like to pay. Collecting from the patient in person is an art form. Your scheduler should indicate all outstanding balances when a patient calls to set-up a follow-up visit. Physicians should not be shy about asking their patient to settle their outstanding balance prior to leaving the office.  Collections from the patient should be a team effort.

See the CMS press release at http://go.cms.gov/kssRvx

Dr. Donald Berwick, head of CMS was quoted in the press release saying, “This payment cut would have serious consequences, and we cannot and will not allow it to happen,” said Dr. Donald M. Berwick, CMS administrator, in a statement. “We need a permanent SGR fix to solve this problem once and for all. That’s why the President’s budget and his fiscal framework call for averting these cuts and why we are determined to pass and implement a permanent and sustainable fix.” Physicians groups have clamored for the SGR (Sustainable Growth Rate) formula to be overhauled as part of the deficit reduction process, but that would also come with a $300BB price tag.

Some provisions of the proposed rule include:

• Physician Quality Reporting System (PQRS) – adding 26 new measures

• Value-based modifier-CY 2013 as the initial performance year

• Meaningful use

• Misvalued code Initiative

• Payment for certain Part B drugs

• 2012 e-prescribing incentive

• Multiple procedure payment reduction (MPPR)

• Physician payment during 3-day payment window

Comments are due back to CMS before August 30th. The final rule is expected by November 1st.

1. Billing Provider Address - Claims are rejecting because the field contains a PO Box or Lock Box address.

2. 9 Digit Zip Code - required for the billing provider. This can be obtained by going to the US postal services website.

3. Provider Accept Assignment Code - claims will be rejected that do not contain a value value for the payers that are live for 5010 transaction (if Live the assignment needs to be “A” for assigned).

4. Priority (Type) of Admission or Visit - payers who are live for 5010 transaction will need a value code for the admission or visit priority. Contact your billing software vendor or your clearing house to insure that you are providing this priority type in the electronic transaction file.

5. Drug Quantity - the CTP segment has been modified to require the drug quantity when a drug is billed. Contact your billing software vendor to insure that the drug quantity is being included in the electronic claims transactions.

Practices must adopt the latest version of the HIPAA electronic transaction standards, Version 5010, by Jan. 1, 2012. These electronic transaction standards include claims, insurance eligibility verification, remittance advice and others.

Commercial health insurers had an average claims-processing error rate of 19.3 percent, a 2 percent increase from 2010, according to the AMA findings, which are based on a random sampling of 2.4 million electronic claims in February and March.

The AMA estimates the increase in overall inaccuracy represents an extra 3.6 million in erroneous claims payments compared to last year and adds $1.5 billion in unnecessary administrative costs. Eliminating health insurer claim payment errors would save $17 billion annually, the AMA estimated.

Physician billing and practice management companies have had to implement new tools and techniques to insure that their clients done feel the effects of this insurance industry trend.  

Nearly two million uninsured Americans are hospitalized each year, with 58 percent of these hospital stays resulting in bills of more than $10,000, the study found. Hospital stays for which the uninsured cannot pay in full account for 95 percent of the total amount hospitals bill the uninsured. HHS said some studies estimate that the uncompensated cost of care in the U.S. was between $56 billion and $73 billion in 2008.

 Seven Keys to Compliance Success

1. Internal monitoring and auditing needs to be performed on a scheduled basis by well trained and experienced auditors.
2. There should be clearly written and well communicated compliance program and practice standards.
3. Designate a compliance officer.
4. Maintain a high quality training and education program for all staff members.
5. Insure that the lines of communications are open and allow concerned employees to speak freely, without fear of reprisals.
6.  If a problem is identified, have a plan of action to investigate, and take corrective action if required.
7. Enforce the compliance plan without exception.

 Anesthesiologists should be aware of areas that will draw attention from governmental payers and Recovery Audit Contractors (RACs). Facet injections have been the subject of recent OIG reports. Anesthesia start and stop times and protocol for transfer of care have received recent attention from governmental payers also.

Anesthesiologist billing codes are always changing so stay posted to make sure you are on top of them. Anesthesia Resource can provide anesthesiologist with the resources and support they need to handle all their billing needs.

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. On October 1, 2013, the number of codes will increase to 155,000 under the ICD-10.

Changes in the anesthesiologist billing codes

• ICD-10-CM codes will have three to seven digits.
• Digit one is alpha (A-Z, not case sensitive).
• Digit two is numeric.
• Digit three is alpha (not case sensitive) or numeric.
• Digits four to seven are alpha (not case sensitive) or numeric.

These changes and others mean that the diagnosis codes you are used to reporting will no longer be there. Many diagnosis codes will include more details than their present counterparts, and some sub-codes of the family will even move to different locations.

There will need to be significant education and training for coders, billers, practice managers, physicians and other health care personnel to fully implement this major code change. According to AACP, ICD-10 will change everything. They also said the big differences between the two systems are ones that will affect billing for information technology and software for anesthesiologist practices.

The U.S. Department of Health and Human estimates that “the percent of returned claims may peak at around six percent to 10 percent of the pre-implementation levels” for the first three to six months post-implementation, and that practices will experience elevated claims-processing costs for the first three years of the implementation of these new anesthesiologist billing codes.

CD-10 is currently active in almost every country in the world, except the United States. The ICD-9 code set is more than 30 years old and is obsolete. One good thing about the new anesthesiologist billing codes is that studies find them to be more logical. Other benefits of the system include the following:

• More-accurate payments for new procedures.
• Fewer miscoded, rejected, and improper reimbursement claims.
• Better understanding of the value of new procedures.
• Improved disease management.
• Better understanding of health care outcomes.

According to estimates by the Medical Group Management Association, the average cost of upgrading to ICD-10 for a three-physician practice will be $84,000 for a practice that does all of its own billing and management.

Overall, the new rules will require more work for awhile. And more work means less time for you and your practice. As an anesthesiologist, why not outsource your billing to someone who has the knowledge to make the switch without slowing down the process and costing your practice money?

Anesthesia billing companies will be sure to have their systems updated and staff trained so they can continue to help their clients save money and time.

Contact us today and let us help you with your anesthesiologist billing needs.

MedPAC also recommended 1 percent updates in 2012 for outpatient dialysis centers, and hospice. For ambulatory surgical centers (ASCs), Congress should implement a 0.5 percent increase in calendar year 2012 while requiring ASCs to submit cost and quality data. Skilled nursing facilities (SNFs) would get no update in fiscal year 2012, according to MedPAC, which also called for Congress to establish a quality incentive payment for SNFs and for SNFs to report more accurate diagnostic and service-use information. MedPAC criticized the amount of fraud that occurs in home health agencies and advised HHS to redesign how it pays for home healthcare. The Commission also recommends that HHS investigate financial relationships and patterns of referrals between nursing homes and hospice and asked Congress to change Medicare’s payment to hospice.

This means that the anesthesia rates will go up slightly in 2012.

Most patients are covered by insurance and have provided these details to the physician beforehand. The responsibility then lies with the physician to submit claims in order to get paid. Companies that provide anesthesia billing service, like us at Anesthesia Resource, are aware of the differences, including the following:

• Procedures must be followed properly to ensure that medical direction is covered.

  An anesthesiologist can direct up to four CRNAs or residents at the same time, but they must meet certain criteria in order for medical direction to be reimbursed by the insurance payer. The criteria for a successful anesthesia billing includes seven steps:

  1. Perform a pre-anesthesia exam and evaluation.
  2. Prescribe the anesthesia plan.
  3. Personally take part in the most demanding procedures of the anesthesia plan, which includes
     induction and emergence.
  4. Be certain that any procedures in the anesthesia plan that he doesn’t perform are performed by a
     qualified CRNA.
  5. Monitor the course of the administration of anesthesia in intervals.
  6. Be physically present and available for immediate diagnosis and treatment of emergencies.
  7. Provide the post-anesthesia care indicated.

The documentation must be detailed and complete in order to secure reimbursement.

• Concurrency, which is defined as the maximum number of procedures that the provider is medically directing within the context of a single procedure and whether the other procedures overlap each other.

  A provider can either be medically directing or supervising. A physician who is providing Medical Direction in concurrent cases cannot ordinarily be involved in furnishing additional services to other patients.

  If the medical professional leaves the immediate area of the operating suite for a long time or devotes extensive time to an emergency case or is otherwise not available to respond to the immediate needs of the surgical patients, the physician’s services to the surgical patients are supervisory in nature and are not billable as Medical Direction.

  If you don’t explicitly document changes and processes, your anesthesia service billing could be audited.

• The physical status of the patient. Many anesthesia procedures are performed under difficult circumstances when the patent’s physical status is impaired. It’s important to know proper physical status modifiers. Qualifying circumstance also adds to the complexity of the anesthesia procedure and is reported by using qualifying circumstance codes. The ASA has a Physical Status Classification System. Their system has six categories:
  1. A normal healthy patient.
  2. A patient with mild systemic disease.
  3. A patient with severe systemic disease.
  4. A patient with severe systemic disease that is a constant threat to life.
  5. A moribund patient who is not expected to survive without the operation.
  6. A declared brain-dead patient whose organs are being removed for donor purposes.

The difficulty of making sense of all the differences and specifics of anesthesia billing is why companies provide this service. We want to make your life easier by taking care of the technical and administrative details for you, allowing you to grow your business.

Contact us today and lets talk about becoming your anesthesia billing service.