Tagged with Anesthesia
Cigna Clinical, Reimbursement, and Administrative Policy Updates
Cigna has released its latest clinical, reimbursement, and administrative policy updates, which includes policy updates for certain anesthesia services, care integration services, and E & M services.
“Flip’n Surgeons” –Calculating the Utilization Rate of Surgeons Who Flip Operating Rooms
By Joe Laden, Vice President Client Management Surgeons who “flip” ORs have two simultaneous operating rooms allocated to them and, therefore, have two anesthesiologists or two anesthesia care teams in these ORs. For a very busy surgeon, this is usually good for the surgeon, hospital, and the anesthesiology group. However, some surgeons would like to…
To Hold, or Not to Hold – That is the Question. Delaying Claim Filing to Avoid Deductibles.
By Joe Laden, Vice President Client Management Effective collection of patient insurance deductibles is an increasing problem for anesthesiologists. Anesthesia claims are usually ready to file a few days after the date of service and can typically reach insurers before claims by the hospital and the surgeon. If the anesthesia claim hits the payer first…
Your Anesthesia Net Collection Ratio – Can it be 100%?
By Joe Laden, Vice President of Client Management The short answer: “Yes, but probably not.” Typically, the Net Collection Ratio (NCR) is calculated as Payments / (Charges – Contractual Adjustments). If contracted payers paid all your charges with nothing left to patients or secondary payers, the Net Collection ratio would be 100%, assuming that all…
Some Healthcare Costs Are Going Down. Are yours?
By Joe Laden, Vice President of Client Management Overall healthcare costs have been rising over the years, due to factors such as the aging population and increased use of medical technology. The administration of healthcare reimbursement to providers accounts for a significant portion of healthcare costs, and some of these administrative costs have been decreasing…
CMS, HHS Proposes Changes to Stark Law and Anti-Kickback Statute Reforms
On October 9, the Department of Health and Human Services (HHS) announced proposed changes that seek to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the Stark Law) and the Federal Anti-Kickback Statute. The proposed rule has been designed to provide greater certainty for healthcare providers participating in value-based arrangements and providing coordinated care for patients. The proposed changes are intended to ease the compliance burden for healthcare providers across the industry while maintaining strong safeguards to protect patients and programs from fraud and abuse.
UnitedHealthcare Expands Prior Auth Requirements and Site-of-Service Medical Necessity Reviews for Certain Surgeries
UnitedHealthcare has expanded prior authorization requirements and site of service medical necessity reviews for certain surgeries in an effort to shift surgical procedures to less expensive locations.
CMS Advances ‘Patients over Paperwork’ Initiative Under Final Rule
On September 26, CMS issued The Omnibus Burden Reduction (Conditions of Participation) Final Rule, which advances the ‘Patients over Paperwork’ initiative aimed at reducing administrative costs in healthcare.
Texas to Receive Increase in Federal Funds for Uncompensated Care
The Texas Health and Human Services Commission announced, on October 1, that the state will be given $11.6 billion over the next three years to help reimburse health care providers for indigent services and is intended to benefit hospitals, clinics, public ambulance, and dental providers.
House Ways and Means Committee Chairman Proposes New Approach to End Surprise Medical Bills
In a letter to the House Ways and Means Committee, Chairman Richard Neal has proposed that the Departments of Health and Human Services (HHS), the U.S. Labor and Treasury Department, along with other interested parties, consolidate their efforts to develop standards for rates for surprise bills.
Proposed Legislation Aims to Improve Provider Directories Accuracy
Two physician lawmakers have proposed new legislation that aims to improve the accuracy of information in health plan provider directories and protect patients from surprise out-of-network bills. The Improving Provider Directories Act (HR 4575) would require health plans to provide an avenue for people to report errors in provider directories, in a “highly visible way”.
Executive Order Issued to Protect Traditional Medicare and MA Plans
The president, on October 3, signed an executive order directing the Department of Health and Human Services to increase efforts to provide more insurance plan options under Medicare Advantage and to remove regulations that are considered burdensome to health care providers. The order is intended to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.
The Secret Ace up Your Sleeve – Using Your Anesthesia Billing Vendor for Stipend Negotiations
By Joe Laden, Vice President of Client Management Many anesthesiology practices rely on financial support from their hospital. This is commonly due to poor payer mix, underutilization of operating rooms and/or intensive in-house call requirements. Requests for hospital financial support must be backed up with solid information showing that anesthesia personnel costs based on hospital…
Anesthesia RCM Specialty Challenges
By Joe Laden, Vice President Client Management Anesthesia billing and coding is an array of unique and complex specialty requirements not found in other medical specialties. Though many billing and coding companies claim experience and expertise in anesthesia billing, the truth, when compared against actual performance, tells a different story. Given the unique aspects of…
Infographic – Advantage Healthcare Solutions – Anesthesia Services
AdvantEdge Healthcare Solutions is a national top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for anesthesia practices since 1989. If you have questions about how AdvantEdge can improve your anesthesia billing and coding so that you are collecting every dollar that you’re legally and ethically entitled, please call us…
CMS Issues Renewed Guidance to Ensure Medicaid Program Integrity
On June 20, CMS released a renewed guidance to state Medicaid agencies that outlines the necessary assurances that states should make to ensure that program resources are reserved for those who meet eligibility requirements.
CMS Releases 2018 ACA Risk-Adjustment Data
CMS, on June 28, released its report summary of the Affordable Care Act (ACA) risk adjustment program for the 2018 benefit year. The analysis found that 572 health insurers offering ACA plans participated in the program in 2018, and transfers between the companies totaled $10.4 billion.
CMS Issues FAQs on BPCI Advanced Model
CMS, on June 21, issued several new or updated frequently asked questions documents on the Bundled Payments for Care Improvement (BPCI) Advanced Model, an Advanced Alternative Payment Model launched last October that will run through 2023.
Illinois Physician Group Oppose Proposed Changes to State’s Nurse Practice Act
Seven organizations representing Illinois physicians and dentists, called the Preserve the Anesthesia Care Team, are protesting the proposed Illinois House Bill 2813, that if passed, would allow Certified Registered Nurse Anesthetists (CRNAs) to administer anesthesia without the physical presence of a medical doctor or dentist.
ICD-10-CM Coding Changes Released for FY 2020
CMS has provided ICD-10-CM coding updates for the fiscal year, starting October 1, 2019 and ending September 30, 2020.
