According to the report, which summarizes actions taken by 10 states to establish health insurance exchanges, officials in New Hampshire, Wyoming, Alaska and Wyoming are likely to pursue insurance exchanges in 2012.

HHS has awarded $729.5 million in planning grants, establishment grants, and innovator grants, according to the report. The agency said it is continuing efforts to develop a federal exchange for states that do not choose to create their own exchanges and will issue guidance in the coming months.

1. Medicare payments remain in flux -  Congress  left Washington late last year after only passing a two month fix for the flawed sustainable growth rate (SGR) formula, despite the fact that they had a full year to address the 2012 cuts. Congress’s inability to avert the 27.4 percent cut for a full year exacerbates uncertainty for physician  payment in 2012.
2. Version 5010 transition - Jan. 1 was the compliance deadline to use Version 5010 standards for electronic claims and other HIPAA transactions. MGMA research indicated that some practice trading partners, including practice management system vendors and health plans, were not able to meet the deadline.
3. E-prescribing  penalties begin in 2012 - A 1% penalty will be levied in 2012 for physicians who are eligible for the Medicare e-prescribing program and did not successfully e-prescribe in 2011 or have a hardship exemption request approved by the Centers for Medicare & Medicaid Services (CMS). E-prescribing penalties increase to 1.5 % in 2013 and to 2.0% in 2014.
4. Countdown to ICD-10 - The healthcare industry has been focused on transitioning to HIPAA Version 5010 electronic transaction standards, but 5010 is only a stepping stone to implement ICD-10, the new diagnosis code set. The industry must transition from ICD-9 to ICD-10 by Oct. 1, 2013. This new code set is vastly more complex.
5. 2012 elections - Campaigns are underway for the 2012 elections, which could change the political landscape for the next four years and have a significant impact on health policy, including repeal or further implementation of healthcare reform.
6. Continued emphasis on compliance - Both  Congress and CMS continue to focus on curbing fraud, waste and abuse in public health programs, such as Medicare and Medicaid. Medicare recovers more than $7 for every $1 spent on fraud investigations, according to government data. Group practices should be prepared for new compliance initiatives.
7. The Supreme Court hearing on ACA - Justices will hear challenges to the constitutionality of the 2010 healthcare reform bill, the Patient Protection and Affordable Care Act (ACA).
8. CMS explores alternative payment models - The Center for Medicare & Medicaid Innovation (CMMI) and CMS continue to explore payment models that move away from the current fee-for-service reimbursement method.
9. Focus on site of service payment differentials - The Medicare Payment Advisory Commission and Congress are taking a closer look at payment differences for identical services across delivery settings, including the difference between payments made to hospitals and physician practices.       
10. EHR meaningful use incentives continue - The  second year of the Medicare EHR incentive program is important because  2012 is the last year that physicians can start participating and earn the maximum amount of $44,000 over five years per eligible professional.

Under HIPAA, all physicians and other healthcare providers that submit claims electronically are required to transition to the Version 5010 transactions by Jan. 1, 2012. Practices that wish to continue having payments sent to a PO box or lock box must report this address in the “pay-to” address field.

Practice administrators should ensure that their practice management system vendor, billing service or clearinghouse has made this change. Practices must update their address information before Jan. 1 to prevent claims rejections and interruptions in cash flow.  Commercial payer are implementing the 5010 standards as well, so be ready to trouble shot the commercial payers claims denials or prepare for a significant cash flow impact.

Visit mgma.com/5010 or the CMS Web site for more information on the change to Version 5010.

This year’s reports—released in March and June—are no different. They include a number of proposals that could affect payment for inpatient, outpatient, and physician services, and the June report contemplates changes to the Medicare benefit structure. Providers should understand how these proposals will affect them and develop strategies to mitigate their impact.

To read the full article

For those that haven’t seen it, the program shows Cesar being invited to a home to train dogs that have behavioral problems. It is interesting to see how Cesar is able to bring balance to the dogs behavior. But more compelling is the dog owners’ transformation.

Even thought the show is about dogs, it is really more about humans. As one author put it, Cesar showed [the owners] that their own unconscious issues were being manifested by the dogs. Aggression in the dog may have been covering for some weakness in the owner. By helping the owner become “calm, assertive,” the dog fell back into a calm submissive and balanced state.

Just like Cesar teaches dog owners that their unconsciousness is what may be dictating their dogs behaviors, as anesthesia practice leaders, we must also consider that our behaviors as managers may be driving problems among partners and employees.

To create the change that we want in our anesthesia practices, we have to look at ourselves first and adjust our behavior in order to see the change we want in others.

In a letter written to MedPAC in response to the proposed plan, ASA President Mark A. Warner, M.D., expresses strong opposition to the commission’s draft recommendation.  Dr. Warner writes, “While we support permanently fixing the SGR, we believe cutting payment for anesthesia by 5.9 percent each year over the next three years, followed by a freeze in payment would harm patient access to care and does not take into account that Medicare currently pays anesthesiologists only 33 percent of the average commercial insurance payment for the same service.”

The proposed 10 year plan would differentiate specialty physicians from primary care physicians in regards to Medicare payments.  For specialty physicians, the draft recommendation would reduce payments 5.9 percent annually in years 2012, 2013 and 2014, followed by payment freezes for the final seven years. Payments for primary care specialties would be exempt from the payment reductions and would instead be frozen at current 2011 levels for the entirety of the 10-year period. 

ASA will continue to update members on the latest MedPAC developments.

Click here to read the letter ASA sent to MedPAC. 

The survey of more than 800 administrators and physicians found that 58 percent said they were in the process of forming ACOs or are considering doing so, while 42 percent said their facilities would not be forming ACOs in the foreseeable future.

Of the administrators and physicians moving toward ACOs, 42 percent said physician alignment is the most serious obstacle to their efforts. Forty percent of the physicians and administrators who are not forming ACOs said physician alignment was the reason.

Other obstacles to forming ACOs included lack of capital, the absence of integrated IT systems, and no evidence-based treatment protocol data, according to the survey.

The updated version of the transactions will have data reporting requirements that are different from the current ones.

Two changes in the billing guidelines

1. In the 4010A1 version of the professional claim transaction, anesthesia services may be reported in actual minutes or in units of time. In the 5010 version, only actual minutes may be reported.
2. This change involves the reporting of the billing provider address. In 5010, the address can no longer be a PO Box or lock-box address.

Benefits of the new 5010 change in anesthesia billing guidelines

- The 4010 was introduced in 2000. Since this time, the ASC X12 Committee has been working to identifying technical issues, accommodating new business needs and removing inconsistencies in the standard.
– The 5010 is intended to implement these improvements, to reduce the number of ambiguities in the implementation guides and to remove unused content from the 4010 format.
– Of particular importantance are the modifications required by the 5010 that are a prerequisite to the move from ICD-9 to ICD-10 coding, since anesthesiologist billing codes will increase in 2013.

Start making changes now

It is recommended that all anesthesia practices and anesthesia management companies make changes to their billing guidelines and systems now. You’ll need to be ready in before the compliance deadline to avoid transaction rejections and subsequent payment delays.

The American Medical Association provided several steps that your practice or anesthesia management company can take.

Step one is to become familiar with the upgrade and conduct an internal impact analysis to determine the impact the change to 5010 will have on your business practices and systems.

Step two is contact your vendors, payers, billing service, and clearinghouse.

Step three is to undergo installation of upgrades from your vendor.

Step four is to conduct internal testing of your systems to ensure you can generate the 5010 transactions.

Step five is to contact your clearinghouses, billing service, and payers to conduct external testing with them.

Step six is to make the switch to 5010. You are permitted to begin using the 5010 transactions prior to the compliance date, as long as you and the other organization are in agreement with the early conversion.

After January 1, 2012, you should monitor the submission and receipt of 5010 transactions to ensure they are working properly. Deadlines for some changes are pushed back but don’t expect there to be a delay in the compliance deadline. The Centers for Medicare & Medicaid Services (CMS) has made it clear that there will be no extension of the deadline for 5010.
Now that you know changes are coming to anesthesia billing guidelines make sure your practice and/or your management company start preparing now.

Contact us today and let us keep tabs on the anesthesia billing guidelines for you so you.