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
Anesthesia Billing Service: 3 Differences from General Procedures
Billing for anesthesia service is a complicated process. It’s different from the billing process of general procedures. The codes and requirements are also always changing.
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:
- Perform a pre-anesthesia exam and evaluation.
- Prescribe the anesthesia plan.
- Personally take part in the most demanding procedures of the anesthesia plan, which includes
induction and emergence. - Be certain that any procedures in the anesthesia plan that he doesn’t perform are performed by a
qualified CRNA. - Monitor the course of the administration of anesthesia in intervals.
- Be physically present and available for immediate diagnosis and treatment of emergencies.
- Provide the post-anesthesia care indicated.
- 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:
- A normal healthy patient.
- A patient with mild systemic disease.
- A patient with severe systemic disease.
- A patient with severe systemic disease that is a constant threat to life.
- A moribund patient who is not expected to survive without the operation.
- A declared brain-dead patient whose organs are being removed for donor purposes.
The documentation must be detailed and complete in order to secure reimbursement.
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.
