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Understanding the Value of CRNA ServicesHOW TO FIGURE OUT WHAT YOU ARE WORTH

Sallie M. Poepsel PhD, MSN, CRNA, APRNAANA Region IV Director

Nebraska

Association

of

Nurse Anesthetists

Spring Meeting

April 27-29, 2018

FULL DISCLOSURE

I am from the “Show-me-State”…used to describe the character of Missourians; “not gullible, conservative, and unwilling to believe without adequate evidence”

Duncan, 1899

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OBJECTIVES

• Describe the relationship between CPT and the RVG

• Use the RVG in computing billable and projected reimbursements for anesthesia services.

• Determine the monetary value of anesthesia services

• Using available app(s) compute the billable anesthesia charges and projected reimbursement given select case scenarios

FACTS ON BILLING

• Highly technical• Legal & liability implications• Coding accuracy a MUST• Speedy and Efficient• Knowledge of Allowable Reimbursements

(CMS)

DEFINITIONS

• CPT: Current Procedural Terminology

• RVG: Relative Value Guide

• TM: Time Modifiers; 15 min. = 1 unit

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DEFINITIONS

• MODIFIERS: physical status; age,

events

• CF: Conversion Factors or Cost/Unit

CPT CODES: Examples

• 00836 INGUINAL HERNIORRHAPHY

• 00790 LAP. CHOLECYSTECTOMY

• 00740 EGD

• 00560 CABG

• 01382 R KNEE ARTHROSCOPY

• 01402 L TOTAL KNEE REPLACEMENT

• 00600 C4-5,C5-6 MICRODISCECTOMY

Doing the Math

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How to calculate Reimbursement

• Base Unit +

• Time Units

x

• Conversion

Factors

• Billable Units

• Allowable Reimbursement

RVG BASE UNITS for CPTs

• 00560 CABG 15 + TM

• 01382 R KNEE ARTHROSCOPY 7 + TM

• 00600 C4-5,C5-6 MICRODISCECTOMY 10 + TM

CASE SCENARIO

A 45 year-old female ASA II underwent an elective lap. cholecystectomy. Anesthesia start time was 0715; after completion of the surgery, patient was transferred to PACU @ 0815. The CRNA after giving report ended anesthesia time @ 0820.

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Compute Billable Units

• CPT code for laparoscopic Cholecystectomy:

_______

Base units using the RVG: _____

Time Units: _____

Modifiers: _____

Total Units: _____

ANESTHESIA BILLABLE UNITS

• 1) Specify the CPT

• 2) Determine the TM

• 3) Identify other modifiers if any

• 4) Compute the total anesthesia units

Compute Billable Units

• CPT code for laparoscopic Cholecystectomy:

• Base units using the RVG: 7

• Time Units: 4.3

• Modifiers: 0

• Total Units: 12.3

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TOTAL ANESTHESIA CHARGES

• 5) Determine the Conversion Factor (CF) for the

CPT:

Insurance provider: BCBS, Aetna,

Healthlink

CMS (Medicare)

Total Anesthesia Charges

• Total Anesthesia Billable Units: • Conversion Factor: BC/BS

$50.00/unit x 12.3total units• TOTAL CHARGES: $ 615.00

GROUP WORK

• Group I

• Group II

• Group III

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Case Scenario # 1

• A 55 year-old female with stable HTN, smoker, has GERD and a BMI of 39. Had exploratory lap - total abdominal hysterectomy with anesthesia time lasting from 1005-1205.

• Payor Mix: Mercy CF: $ 60/unit

Case Scenario # 2

• A 55 year-old female ASA II who underwent lap assisted vaginal hysterectomy BSO. Total anesthesia time 3 hours.

• Payor Mix: GHP; CF: $72/unit

Case Scenario # 3

• A 70 year-old male, with COPD, DM, Hyperlipidemia and HTN. Had total knee arthroplasty with anesthesia time from 0807 hrs. to 1039 hrs.

• Payor Mix: Medicare; CF: $22.74/unit

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END-OF-YEAR :IMPACT OF PAYER MIX

PAYER MIX: Medicare = $20.43 (450 cases) 12 units

GHP = $72.00 (100 cases) 8 units

Mercy = $60.00 ( 98 cases) 14 units

BC/BS = $75.00 (132 cases) 10 units

TOTAL… 780 cases

Anesthesia Charges

• MEDICARE:5,400 units X $20.43 = $ 110,322.00

• GHP : 800 units X $72.00 = $ 57,600.00

• Mercy :1,372 units X $60.00 = $ 82,320.00

• BC/BS :1,320 units X $75.00 = $ 99,000.00

TOTAL….. $ 349,242.00

CRNA Compensation

BASE SALARY $ 182,000.00 BENEFITS: (23%)

6 wks ETO (240 X 87.55) $21,000.00 (11.5)Profit Sharing $14,000.00 (7%)CME x 1 wk $ 3,500.00 (1.9%)Professional liability insurance: $ 5,000.00 (2.7%)AANA membership fee: $ 645.00 (0.3%)

TOTAL PACKAGE: $226,145.00

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Comparative Analysis

• REVENUE GENERATED: $ 349,242.00 **

• TOTAL COMPENSATION: $ 226,145.00

Case Scenario

• 68 yr old male with ventral hernia repair; smoker, HTN

• Procedure takes one hour

• Medicare coverage

• Conversion factor(CF) = $20.00/unit.

Case Con’t

• CPT: 00832 Ventral hernia

• Base Units: 6 units

• Time: 1 hr: 4 units

• Total units: 10 units x 20.43/unit = $204.30

(Medicare pays 80% = $163.44)

(Patient pays 20% = $ 40.86)

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Case Con’t

• Medicare case 1 hour

• Turn around time 30 minute; + 30 minute lunch

• 15 min breaks x 2

• No of cases you can do: 5 cases/day

• 5 cases x $214.30 = $1021.50 (generated/day)

Case Con’t

• What if you only did Medicare cases?365 days/year = 52 weeks

- 5 weeks vacation = 25 days

- 1 week misc. time

- work 5 days/week + call x 46 weeks

= 5 x 1021.50/day = 5107.5 x 46 = $234,945.00

JUST DOING MEDICARE CASES

Case Con’t

• Therefore: 255K (30% usually would cover benefits)

$178,500 + benefits (30% = 76,500)

Total Compensation package = $ 255,000.00

Bare minimum if you only do Medicare cases!!!

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IMPLICATIONS FOR PRACTICE

• Value of CRNA Services

• Salary/Contract negotiations

• Legal & liability implications

FACTORS TO CONSIDER• knowledge of the value of your

anesthesia services

• vacation time, sick leave.. Whether time

accrues from year to year

• responsibilities of both parties with

regards to the work to be done and the

work environment

(accuracy with Coding & Billing)

QUESTIONS

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THANK YOUThis Photo by Unknown Author is licensed under CC BY-NC-ND