The Basics of Anesthesia Billing Paul W. Santoro CRNA, MS … Fall... · 2018-03-31 · The Basics...
42
The Basics of The Basics of Anesthesia Billing Anesthesia Billing Paul W. Santoro CRNA, MS Paul W. Santoro CRNA, MS November 5, 2011 November 5, 2011 Oregon Association of Nurse Anesthetists Oregon Association of Nurse Anesthetists
Transcript of The Basics of Anesthesia Billing Paul W. Santoro CRNA, MS … Fall... · 2018-03-31 · The Basics...
The Basics of
The Basics of
Anesthesia Billing
Anesthesia Billing
Pau
l W. S
anto
ro C
RN
A, M
SP
aul W
. San
toro
CR
NA
, MS
No
vem
ber
5, 2
011
No
vem
ber
5, 2
011
Ore
gon
Ass
oci
atio
n o
f N
urs
e A
nes
thet
ists
Ore
gon
Ass
oci
atio
n o
f N
urs
e A
nes
thet
ists
Medicare
Medicare
An
esth
esia
bill
ing
and
rei
mb
urs
emen
t st
arts
A
nes
thes
ia b
illin
g an
d r
eim
burs
emen
t st
arts
wit
h a
rev
iew
of
th
e M
edic
are
wit
h a
rev
iew
of
th
e M
edic
are
reim
burs
emen
t ru
les,
sin
ce m
ost
oth
er
reim
burs
emen
t ru
les,
sin
ce m
ost
oth
er
reim
burs
emen
t ru
les,
sin
ce m
ost
oth
er
reim
burs
emen
t ru
les,
sin
ce m
ost
oth
er
pay
ers
use
sim
ilar
met
ho
do
logy
pay
ers
use
sim
ilar
met
ho
do
logy
Medicare Anesthesia Billing History
Medicare Anesthesia Billing History
��A
nes
thes
ia R
eim
burs
emen
t h
as lo
ng
bee
n a
n
An
esth
esia
Rei
mb
urs
emen
t h
as lo
ng
bee
n a
n
exce
pti
on
co
mp
ared
to
oth
er m
edic
al a
nd
ex
cep
tio
n c
om
par
ed t
o o
ther
med
ical
an
d
surg
ical
bill
ing
surg
ical
bill
ing
��R
eso
urc
e B
ased
Rel
ativ
e V
alue
Sca
le
Res
ourc
e B
ased
Rel
ativ
e V
alue
Sca
le
��R
eso
urc
e B
ased
Rel
ativ
e V
alue
Sca
le
Res
ourc
e B
ased
Rel
ativ
e V
alue
Sca
le
(RB
RV
S)
vs. R
elat
ive
Val
ue
Guid
e (R
VG
)(R
BR
VS)
vs. R
elat
ive
Val
ue
Guid
e (R
VG
)
��T
he
reas
on
fo
r th
e d
iffe
ren
ce?
RB
RV
S p
ays
Th
e re
aso
n f
or
the
dif
fere
nce
? R
BR
VS p
ays
per
Pro
ced
ure
, RV
G t
akes
in
to a
cco
un
t th
e p
er P
roce
dure
, RV
G t
akes
in
to a
cco
un
t th
e
“Tim
e fa
cto
r” in
an
esth
esia
del
iver
y“T
ime
fact
or”
in
an
esth
esia
del
iver
y
Medicare Reimbursement
Medicare Reimbursement
Two Resourced
Two Resourced--Based Components
Based Components
::
��B
ase
Val
ue
(or
Bas
e U
nit
s) A
ssig
ns
a B
ase
Val
ue
(or
Bas
e U
nit
s) A
ssig
ns
a
num
eric
un
it v
alue
(Bas
e V
alue)
fo
r ea
ch
num
eric
un
it v
alue
(Bas
e V
alue)
fo
r ea
ch
num
eric
un
it v
alue
(Bas
e V
alue)
fo
r ea
ch
num
eric
un
it v
alue
(Bas
e V
alue)
fo
r ea
ch
surg
ical
pro
ced
ure
bas
ed o
n S
urg
ical
CP
T
surg
ical
pro
ced
ure
bas
ed o
n S
urg
ical
CP
T
cod
eco
de
��T
ime
Val
ue
(or
Tim
e U
nit
sT
ime
Val
ue
(or
Tim
e U
nit
s))ex
pre
ssed
in
ex
pre
ssed
in
15 m
inute
in
crem
ents
15 m
inute
in
crem
ents
Relationship between CPT Code and
Relationship between CPT Code and
Base Units
Base Units
��N
um
ber
of
Surg
ical
CP
T C
od
es =
~N
um
ber
of
Surg
ical
CP
T C
od
es =
~50
0050
00
��N
um
ber
of
An
esth
esia
CP
T C
od
es =
~N
um
ber
of
An
esth
esia
CP
T C
od
es =
~30
030
0
��M
ost
An
esth
esia
Co
des
can
be
cro
ssw
alke
d
Mo
st A
nes
thes
ia C
od
es c
an b
e cr
oss
wal
ked
to
mult
iple
surg
ical
co
des
, so
me
ove
r 20
0to
mult
iple
surg
ical
co
des
, so
me
ove
r 20
0
Base Value (Units)
Base Value (Units)
Considers:
Considers:
��A
nes
thes
ia R
isk
An
esth
esia
Ris
k
An
tici
pat
ed S
urg
ical
Pro
ble
ms
An
tici
pat
ed S
urg
ical
Pro
ble
ms
��A
nti
cip
ated
Surg
ical
Pro
ble
ms
An
tici
pat
ed S
urg
ical
Pro
ble
ms
��Ski
ll L
evel
Req
uir
edSki
ll L
evel
Req
uir
ed
��G
ener
al “
Tim
e” R
equir
edG
ener
al “
Tim
e” R
equir
ed
Time Units
Time Units
��C
alcu
late
d u
sin
g “A
nes
thes
ia”
Star
t an
d S
top
C
alcu
late
d u
sin
g “A
nes
thes
ia”
Star
t an
d S
top
T
imes
Tim
es
��“C
on
stan
t A
tten
dan
ce”
“Co
nst
ant
Att
end
ance
”
��M
edic
are
def
ines
on
e un
it o
f ti
me
as a
15
min
ute
M
edic
are
def
ines
on
e un
it o
f ti
me
as a
15
min
ute
in
crem
ent
(do
es n
ot
roun
d u
nit
s)in
crem
ent
(do
es n
ot
roun
d u
nit
s)in
crem
ent
(do
es n
ot
roun
d u
nit
s)in
crem
ent
(do
es n
ot
roun
d u
nit
s)
��C
alcu
late
d b
y d
ivid
ing
anes
thes
ia t
ime
by
15
Cal
cula
ted
by
div
idin
g an
esth
esia
tim
e b
y 15
m
inute
s, r
oun
ded
to
on
e d
ecim
al p
lace
min
ute
s, r
oun
ded
to
on
e d
ecim
al p
lace
��So
me
Co
mm
erci
al p
ayer
s d
efin
e ti
me
in 1
0 o
r 12
So
me
Co
mm
erci
al p
ayer
s d
efin
e ti
me
in 1
0 o
r 12
m
inute
un
its
(or
may
neg
oti
ate
tim
e un
it)
min
ute
un
its
(or
may
neg
oti
ate
tim
e un
it)
��M
edic
are
pay
s th
e sa
me
anes
thes
ia “
Co
nve
rsio
n
Med
icar
e p
ays
the
sam
e an
esth
esia
“C
on
vers
ion
F
acto
r” f
or
bo
th b
ase
and
tim
e un
its
Fac
tor”
fo
r b
oth
bas
e an
d t
ime
un
its
Discontinuous Time
Discontinuous Time
Can
ad
d b
lock
s o
f ti
me
aro
un
d a
n
Can
ad
d b
lock
s o
f ti
me
aro
un
d a
n
inte
rrup
tio
n in
an
esth
esia
tim
e as
lo
ng
inte
rrup
tio
n in
an
esth
esia
tim
e as
lo
ng
con
tin
uo
us
anes
thes
ia c
are
(co
nti
nuo
us
anes
thes
ia c
are
(“C
on
stan
t “C
on
stan
t co
nti
nuo
us
anes
thes
ia c
are
(co
nti
nuo
us
anes
thes
ia c
are
(“C
on
stan
t “C
on
stan
t
Att
end
ance
”)A
tten
dan
ce”)
is d
eliv
ered
wit
hin
th
e ti
me
is d
eliv
ered
wit
hin
th
e ti
me
per
iod
s ar
oun
d t
he
inte
rrup
tio
n.
per
iod
s ar
oun
d t
he
inte
rrup
tio
n.
Concurrency
Concurrency
The rules to keep in mind:
The rules to keep in mind:
��A
CR
NA
can
on
ly b
e in
on
pla
ce a
t o
ne
tim
eA
CR
NA
can
on
ly b
e in
on
pla
ce a
t o
ne
tim
e
��A
n A
nes
thes
iolo
gist
can
on
ly b
e in
fo
ur
pla
ces
at
An
An
esth
esio
logi
st c
an o
nly
be
in f
our
pla
ces
at
on
e ti
me
(if
bill
ing
med
ical
dir
ecti
on
)o
ne
tim
e (i
f b
illin
g m
edic
al d
irec
tio
n)
��M
ake
sure
th
ere
is o
ne
min
ute
bet
wee
n c
ases
Mak
e su
re t
her
e is
on
e m
inute
bet
wee
n c
ases
��U
se o
ne
clo
ck. F
org
et a
bo
ut
mat
chin
g O
R
Use
on
e cl
ock
. Fo
rget
ab
out
mat
chin
g O
R
tim
es!
tim
es!
Wit
h e
lect
ron
ic s
ub
mis
sio
n t
hes
e d
iscr
epan
cies
are
W
ith
ele
ctro
nic
sub
mis
sio
n t
hes
e d
iscr
epan
cies
are
A
LW
AY
S d
etec
ted
an
d s
low
rei
mb
urs
emen
tA
LW
AY
S d
etec
ted
an
d s
low
rei
mb
urs
emen
t
Concurrency
Concurrency
Med
icar
e d
oes
allo
w a
n A
nes
thes
iolo
gist
to
M
edic
are
do
es a
llow
an
An
esth
esio
logi
st t
o
per
form
so
me
oth
er t
asks
duri
ng
Med
ical
p
erfo
rm s
om
e o
ther
tas
ks d
uri
ng
Med
ical
D
irec
tio
nD
irec
tio
n
��A
dd
ress
an
em
erge
ncy
of
sho
rt d
ura
tio
nA
dd
ress
an
em
erge
ncy
of
sho
rt d
ura
tio
n
Ad
min
iste
r an
ep
idura
l to
lab
ori
ng
pat
ien
tA
dm
inis
ter
an e
pid
ura
l to
lab
ori
ng
pat
ien
t��
Ad
min
iste
r an
ep
idura
l to
lab
ori
ng
pat
ien
tA
dm
inis
ter
an e
pid
ura
l to
lab
ori
ng
pat
ien
t
��P
erfo
rm p
erio
dic
mo
nit
ori
ng
of
an O
B p
atie
nt
Per
form
per
iod
ic m
on
ito
rin
g o
f an
OB
pat
ien
t
��R
ecei
ve p
atie
nts
en
teri
ng
suit
e fo
r th
e n
ext
Rec
eive
pat
ien
ts e
nte
rin
g su
ite
for
the
nex
t su
rger
ysu
rger
y
��C
hec
k o
n o
r d
isch
arge
pat
ien
ts in
th
e P
AC
UC
hec
k o
n o
r d
isch
arge
pat
ien
ts in
th
e P
AC
U
��C
oo
rdin
ate
sch
edulin
g m
atte
rsC
oo
rdin
ate
sch
edulin
g m
atte
rs
Total Payment
Total Payment
To
tal P
aym
ent
($)
=
Co
nve
rsio
n F
acto
r ($
) T
ota
l Pay
men
t ($
) =
C
on
vers
ion
Fac
tor
($)
To
tal P
aym
ent
($)
=
Co
nve
rsio
n F
acto
r ($
) T
ota
l Pay
men
t ($
) =
C
on
vers
ion
Fac
tor
($)
x (S
um
to
tal o
f B
ase
un
its
+ T
ime
un
its)
x (S
um
to
tal o
f B
ase
un
its
+ T
ime
un
its)
Payment Example
Payment Example
��P
roce
dure
: P
roce
dure
: Ven
tral
Her
nia
Rep
air
(008
32)
Ven
tral
Her
nia
Rep
air
(008
32)
��B
ase
Un
its:
B
ase
Un
its:
66
An
esth
esia
Tim
e:
An
esth
esia
Tim
e:
66��
An
esth
esia
Tim
e:
An
esth
esia
Tim
e:
66
��C
on
vers
ion
Fac
tor:
Co
nve
rsio
n F
acto
r:$2
2.67
$22.
67
��T
ota
l P
aym
ent:
T
ota
l P
aym
ent:
$22
.67
* (6
+ 6
) =
$27
2.04
$22.
67 *
(6
+ 6
) =
$27
2.04
Anesthesia Claims Modifiers
Anesthesia Claims Modifiers
Anesthesiologist
Anesthesiologist
��AAAA
––P
erso
nal
ly P
erfo
rmed
by
an
Per
son
ally
Per
form
ed b
y an
A
nes
thes
iolo
gist
An
esth
esio
logi
st
��QK
QK
––M
edic
al D
irec
tio
n o
f tw
o, t
hre
e o
r fo
ur
Med
ical
Dir
ecti
on
of
two
, th
ree
or
four
con
curr
ent
pro
ced
ure
s in
volv
ing
qual
ifie
d
con
curr
ent
pro
ced
ure
s in
volv
ing
qual
ifie
d
con
curr
ent
pro
ced
ure
s in
volv
ing
qual
ifie
d
con
curr
ent
pro
ced
ure
s in
volv
ing
qual
ifie
d
ind
ivid
ual
sin
div
idual
s
��ADAD
––M
edic
al S
up
ervi
sio
n b
y a
ph
ysic
ian
; m
ore
M
edic
al S
up
ervi
sio
n b
y a
ph
ysic
ian
; m
ore
th
an f
our
con
curr
ent
pro
ced
ure
s th
an f
our
con
curr
ent
pro
ced
ure
s
��QY
QY
––M
edic
al D
irec
tio
n o
f o
ne
CR
NA
by
an
Med
ical
Dir
ecti
on
of
on
e C
RN
A b
y an
an
esth
esio
logi
stan
esth
esio
logi
st
Anesthesia Claims Modifiers
Anesthesia Claims Modifiers
CRNA
CRNA
��QX
QX
––C
RN
A w
ith
med
ical
dir
ecti
on
by
a C
RN
A w
ith
med
ical
dir
ecti
on
by
a
ph
ysic
ian
ph
ysic
ian
QZ
QZ
––C
RN
A w
ith
out
med
ical
dir
ecti
on
by
CR
NA
wit
ho
ut
med
ical
dir
ecti
on
by
��QZ
QZ
––C
RN
A w
ith
out
med
ical
dir
ecti
on
by
CR
NA
wit
ho
ut
med
ical
dir
ecti
on
by
a p
hys
icia
na
ph
ysic
ian
Anesthesia Claims Modifiers
Anesthesia Claims Modifiers
Add
Add--ons
ons
��QS
QS
––M
on
ito
red
An
esth
esia
Car
e Ser
vice
sM
on
ito
red
An
esth
esia
Car
e Ser
vice
s
��5959
––D
isti
nct
Pro
ced
ura
l Ser
vice
(in
dic
ates
a
Dis
tin
ct P
roce
dura
l Ser
vice
(in
dic
ates
a
serv
ice
was
in
dep
end
ent
fro
m o
ther
ser
vice
s se
rvic
e w
as in
dep
end
ent
fro
m o
ther
ser
vice
s
per
form
ed o
n t
he
sam
e d
ay)
per
form
ed o
n t
he
sam
e d
ay)
per
form
ed o
n t
he
sam
e d
ay)
per
form
ed o
n t
he
sam
e d
ay)
��5353
––D
isco
nti
nued
Pro
ced
ure
(C
ance
lled
Cas
e D
isco
nti
nued
Pro
ced
ure
(C
ance
lled
Cas
e
afte
r th
e in
duct
ion
of
anes
thes
ia)
afte
r th
e in
duct
ion
of
anes
thes
ia)
��Q6
Q6
––L
ocu
ms
Co
vera
ge (
anes
thes
iolo
gist
L
ocu
ms
Co
vera
ge (
anes
thes
iolo
gist
on
ly)
on
ly)
Medicare’s 7 Physician Rules for
Medicare’s 7 Physician Rules for
Medical Direction
Medical Direction
1.1.P
erfo
rm p
reP
erfo
rm p
re--a
nes
thet
ic e
xam
an
d e
valu
atio
nan
esth
etic
exa
m a
nd
eva
luat
ion
2.2.P
resc
rib
e th
e an
esth
etic
pla
nP
resc
rib
e th
e an
esth
etic
pla
n
3.3.P
erso
nal
ly p
arti
cip
ate
in t
he
mo
st d
eman
din
g P
erso
nal
ly p
arti
cip
ate
in t
he
mo
st d
eman
din
g
asp
ects
of
the
anes
thet
ic, i
ncl
ud
ing
if
asp
ects
of
the
anes
thet
ic, i
ncl
ud
ing
if
app
licab
le in
duct
ion
an
d e
mer
gen
ceap
plic
able
ind
uct
ion
an
d e
mer
gen
ce
4.4.E
nsu
re t
hat
del
egat
ed a
spec
ts o
f th
e E
nsu
re t
hat
del
egat
ed a
spec
ts o
f th
e
anes
thet
ic a
re p
erfo
rmed
by
a qual
ifie
d
anes
thet
ic a
re p
erfo
rmed
by
a qual
ifie
d
ind
ivid
ual
ind
ivid
ual
Medicare’s 7 Physician Rules for
Medicare’s 7 Physician Rules for
Medical Direction
Medical Direction
5.5.M
on
ito
r th
e co
urs
e o
f th
e an
esth
etic
at
Mo
nit
or
the
cours
e o
f th
e an
esth
etic
at
freq
uen
t in
terv
als
freq
uen
t in
terv
als
6.6.R
emai
n p
hys
ical
ly p
rese
nt
and
ava
ilab
le
Rem
ain
ph
ysic
ally
pre
sen
t an
d a
vaila
ble
6.6.
Rem
ain
ph
ysic
ally
pre
sen
t an
d a
vaila
ble
R
emai
n p
hys
ical
ly p
rese
nt
and
ava
ilab
le
for
imm
edia
te d
iagn
osi
s an
d t
reat
men
t o
f fo
r im
med
iate
dia
gno
sis
and
tre
atm
ent
of
emer
gen
cies
emer
gen
cies
7.7.P
rovi
de
ind
icat
ed p
ost
Pro
vid
e in
dic
ated
po
st--a
nes
thet
ic c
are
anes
thet
ic c
are
Medicare’s 7 Physician Rules for
Medicare’s 7 Physician Rules for
Medical Direction
Medical Direction
Th
ese
7 st
eps
must
be
do
cum
ente
d in
th
e T
hes
e 7
step
s m
ust
be
do
cum
ente
d in
th
e
med
ical
rec
ord
as
a co
nd
itio
n o
f p
aym
ent
med
ical
rec
ord
as
a co
nd
itio
n o
f p
aym
ent
Th
ese
are
Med
icar
e re
quir
emen
ts f
or
Th
ese
are
Med
icar
e re
quir
emen
ts f
or
pay
men
t un
der
Med
ical
Dir
ecti
on
, no
t p
aym
ent
un
der
Med
ical
Dir
ecti
on
, no
t
Sta
nd
ard
s o
f C
are
Sta
nd
ard
s o
f C
are
Medical Direction Payment
Medical Direction Payment
��A
nes
thes
iolo
gist
: Q
KA
nes
thes
iolo
gist
: Q
K
��C
RN
A: Q
XC
RN
A: Q
X
��50
:50
split
bet
wee
n A
nes
thes
iolo
gist
an
d C
RN
A50
:50
split
bet
wee
n A
nes
thes
iolo
gist
an
d C
RN
A
An
esth
esio
logi
st c
an c
ove
r up
to
fo
ur
An
esth
esio
logi
st c
an c
ove
r up
to
fo
ur
��A
nes
thes
iolo
gist
can
co
ver
up
to
fo
ur
An
esth
esio
logi
st c
an c
ove
r up
to
fo
ur
con
curr
ent
case
s (c
aptu
rin
g 50
% p
aym
ent
for
con
curr
ent
case
s (c
aptu
rin
g 50
% p
aym
ent
for
each
cas
e)ea
ch c
ase)
��M
ust
mee
t (a
nd
do
cum
ent)
th
e 7
Med
ical
M
ust
mee
t (a
nd
do
cum
ent)
th
e 7
Med
ical
D
irec
tio
n C
on
dit
ion
s o
f P
aym
ent
Rule
s
Dir
ecti
on
Co
nd
itio
ns
of
Pay
men
t R
ule
s
Medical Supervision Payment
Medical Supervision Payment
��A
nes
thes
iolo
gist
co
veri
ng
bey
on
d f
our
An
esth
esio
logi
st c
ove
rin
g b
eyo
nd
fo
ur
con
curr
ent
case
s co
ncu
rren
t ca
ses
��A
nes
thes
iolo
gist
: A
DA
nes
thes
iolo
gist
: A
D
��C
RN
A: Q
XC
RN
A: Q
X��
CR
NA
: QX
CR
NA
: QX
��50
% o
f to
tal av
aila
ble
pay
men
t to
CR
NA
(as
in
50%
of
tota
l av
aila
ble
pay
men
t to
CR
NA
(as
in
Med
ical
Dir
ecti
on
)M
edic
al D
irec
tio
n)
��A
nes
thes
iolo
gist
pai
d 3
bas
e un
its,
plu
s an
A
nes
thes
iolo
gist
pai
d 3
bas
e un
its,
plu
s an
ad
dit
ion
al u
nit
if t
hey
par
tici
pat
e (a
nd
ad
dit
ion
al u
nit
if t
hey
par
tici
pat
e (a
nd
d
ocu
men
t) in
In
duct
ion
do
cum
ent)
in I
nd
uct
ion
Personally Performed Payment
Personally Performed Payment
��A
nes
thes
iolo
gist
: AA
A
nes
thes
iolo
gist
: AA
��C
RN
A: Q
ZC
RN
A: Q
Z
��B
oth
Pro
vid
ers:
100
% o
f av
aila
ble
pay
men
t B
oth
Pro
vid
ers:
100
% o
f av
aila
ble
pay
men
t
Blocks: are they billable as a
Blocks: are they billable as a
separate service?
separate service?
��B
asic
Ques
tio
n: A
re t
hey
fo
r th
e o
per
ativ
e
Bas
ic Q
ues
tio
n: A
re t
hey
fo
r th
e o
per
ativ
e
An
esth
etic
or
Po
stA
nes
thet
ic o
r P
ost
--op
erat
ive
Pai
n C
on
tro
l?o
per
ativ
e P
ain
Co
ntr
ol?
��B
lock
w
ith
MA
C o
r a
Gen
eral
An
esth
etic
B
lock
w
ith
MA
C o
r a
Gen
eral
An
esth
etic
duri
ng
the
op
erat
ive
case
?d
uri
ng
the
op
erat
ive
case
?d
uri
ng
the
op
erat
ive
case
?d
uri
ng
the
op
erat
ive
case
?
��D
ocu
men
t in
th
e re
cord
“fo
r p
ost
Do
cum
ent
in t
he
reco
rd “
for
po
st--o
per
ativ
e o
per
ativ
e
pai
n”
pai
n”
��M
ake
sure
yo
ur
bill
ers
un
der
stan
d a
nd
will
M
ake
sure
yo
ur
bill
ers
un
der
stan
d a
nd
will
loo
k fo
r th
e ad
ded
do
cum
enta
tio
nlo
ok
for
the
add
ed d
ocu
men
tati
on
Procedures and Procedure Codes
Procedures and Procedure Codes
��Se
con
dar
y C
od
e: 5
9Se
con
dar
y C
od
e: 5
9
��In
vasi
ve M
on
ito
rin
gIn
vasi
ve M
on
ito
rin
g
��P
ain
Man
agem
ent
Pai
n M
anag
emen
t
��E
mer
gen
cy I
ntu
bat
ion
Em
erge
ncy
In
tub
atio
n��
Em
erge
ncy
In
tub
atio
nE
mer
gen
cy I
ntu
bat
ion
��M
edic
are
use
s “n
on
Med
icar
e use
s “n
on
--an
esth
esia
” C
TP
co
des
, an
esth
esia
” C
TP
co
des
, use
d b
y al
l p
rovi
der
suse
d b
y al
l p
rovi
der
s
��P
aym
ent
bas
ed o
n t
he
ph
ysic
ian
RB
RV
S fe
e P
aym
ent
bas
ed o
n t
he
ph
ysic
ian
RB
RV
S fe
e sc
hed
ule
sch
edule
��“F
lat
Fee
” w
ith
out
allo
wan
ce f
or
actu
al t
ime
“Fla
t F
ee”
wit
ho
ut
allo
wan
ce f
or
actu
al t
ime
Physician Quality Reporting Initiative
Physician Quality Reporting Initiative
(PQRI)
(PQRI)
��Sta
rted
in
lat
e 20
07Sta
rted
in
lat
e 20
07
��In
itia
lly 7
4 M
easu
res
acro
ss a
ll sp
ecia
ltie
sIn
itia
lly 7
4 M
easu
res
acro
ss a
ll sp
ecia
ltie
s
��M
ust
rep
ot
mea
sure
s o
n ≥
80%
of
Cla
ims
Must
rep
ot
mea
sure
s o
n ≥
80%
of
Cla
ims
��M
ust
rep
ot
mea
sure
s o
n ≥
80%
of
Cla
ims
Must
rep
ot
mea
sure
s o
n ≥
80%
of
Cla
ims
wit
h a
pp
licab
le S
urg
ical
CP
T c
od
esw
ith
ap
plic
able
Surg
ical
CP
T c
od
es
��C
urr
entl
y ab
out
Curr
entl
y ab
outReporting not Achieving
Reporting not Achieving
��C
urr
ent
An
esth
esia
Mea
sure
: (#
30)
Tim
ely
Curr
ent
An
esth
esia
Mea
sure
: (#
30)
Tim
ely
Ad
min
istr
atio
n o
f A
nti
bio
tic
Pro
ph
ylax
isA
dm
inis
trat
ion
of
An
tib
ioti
c P
rop
hyl
axis
��E
ligib
le f
or
1.5%
Med
icar
e B
on
us
Elig
ible
fo
r 1.
5% M
edic
are
Bo
nus
Physician Quality Reporting
Physician Quality Reporting
Initiative (PQRI)
Initiative (PQRI)
Other Proposed Anesthesia Measures:
Other Proposed Anesthesia Measures:
��P
reve
nti
on
of
Cat
het
erP
reve
nti
on
of
Cat
het
er--R
elat
ed B
loo
dst
ream
R
elat
ed B
loo
dst
ream
In
fect
ion
sIn
fect
ion
sIn
fect
ion
sIn
fect
ion
s
��P
reve
nti
on
of
Ven
tila
tor
Pre
ven
tio
n o
f V
enti
lato
r--A
sso
ciat
ed P
neu
mo
nia
Ass
oci
ated
Pn
eum
on
ia
��P
erio
per
ativ
e T
emp
erat
ure
Mea
sure
men
t fo
r P
erio
per
ativ
e T
emp
erat
ure
Mea
sure
men
t fo
r Su
rgic
al P
atie
nts
Un
der
Gen
eral
An
esth
esia
Surg
ical
Pat
ien
ts U
nd
er G
ener
al A
nes
thes
ia
��St
ress
Ulc
er D
isea
se P
rop
hyl
axis
in
Ven
tila
ted
St
ress
Ulc
er D
isea
se P
rop
hyl
axis
in
Ven
tila
ted
P
atie
nts
Pat
ien
ts
Other Payers
Other Payers
��M
ost
Co
mm
erci
al P
ayer
s fo
llow
th
e M
ost
Co
mm
erci
al P
ayer
s fo
llow
th
e
Med
icar
e R
eim
burs
emen
t R
ule
s to
on
e M
edic
are
Rei
mb
urs
emen
t R
ule
s to
on
e
deg
ree
or
ano
ther
deg
ree
or
ano
ther
deg
ree
or
ano
ther
deg
ree
or
ano
ther
��U
nd
erst
and
th
e d
iffe
ren
ces
so y
ou w
ill b
e U
nd
erst
and
th
e d
iffe
ren
ces
so y
ou w
ill b
e
awar
e o
f an
y sp
ecia
l b
illin
g re
quir
emen
tsaw
are
of
any
spec
ial b
illin
g re
quir
emen
ts
��K
no
w t
he
Co
nve
rsio
n F
acto
rsK
no
w t
he
Co
nve
rsio
n F
acto
rs
��C
RN
A P
aym
ent
(Sp
lit, P
roce
dure
s, e
tc)
CR
NA
Pay
men
t (S
plit
, Pro
ced
ure
s, e
tc)
The Simple Things To Do
The Simple Things To Do
��E
DU
CA
TE
yo
ur
Pro
vid
ers
ED
UC
AT
E y
our
Pro
vid
ers
��W
hat
is b
illab
le a
nd
ho
w t
o d
ocu
men
t it
Wh
at is
bill
able
an
d h
ow
to
do
cum
ent
it
��E
DU
CA
TE
yo
ur
Bill
ers
ED
UC
AT
E y
our
Bill
ers
��W
hat
to
loo
k fo
r o
n t
he
reco
rd a
nd
wh
ere
it
Wh
at t
o lo
ok
for
on
th
e re
cord
an
d w
her
e it
w
ill b
e d
ocu
men
ted
(lin
es, p
ost
will
be
do
cum
ente
d (
lines
, po
st--o
p b
lock
s,
op
blo
cks,
d
isco
nti
nuo
us
tim
e, p
roce
dure
s)d
isco
nti
nuo
us
tim
e, p
roce
dure
s)
��D
evel
op
a g
oo
d “
Fro
nt
Dev
elo
p a
go
od
“F
ron
t--E
nd
” P
roce
ssE
nd
” P
roce
ss
��R
eco
rds
Man
agem
ent,
Sub
mis
sio
ns
Rec
ord
s M
anag
emen
t, S
ub
mis
sio
ns
��A
nes
thes
ia R
eco
rds
Rev
iew
An
esth
esia
Rec
ord
s R
evie
w
The Simple Things To Do
The Simple Things To Do
��A
void
Co
ncu
rren
cy P
rob
lem
s A
void
Co
ncu
rren
cy P
rob
lem
s
��C
aptu
re D
isco
nti
nuo
us
Tim
eC
aptu
re D
isco
nti
nuo
us
Tim
e
��C
aptu
re “
Po
stC
aptu
re “
Po
st--O
p”
Pai
n B
lock
sO
p”
Pai
n B
lock
s��
Cap
ture
“P
ost
Cap
ture
“P
ost
--Op
” P
ain
Blo
cks
Op
” P
ain
Blo
cks
��C
aptu
re P
roce
dure
s (L
ines
, In
tub
atio
n)
Cap
ture
Pro
ced
ure
s (L
ines
, In
tub
atio
n)
��L
ocu
ms
Bill
ing
Lo
cum
s B
illin
g
��Set
Ch
arge
Rat
e h
igh
en
ough
to
cap
ture
Set
Ch
arge
Rat
e h
igh
en
ough
to
cap
ture
outl
iers
outl
iers
Not So Simple Things To Do
Not So Simple Things To Do
��Sec
ure
“go
od
” C
om
mer
cial
Co
ntr
acts
Sec
ure
“go
od
” C
om
mer
cial
Co
ntr
acts
��A
ccura
te C
od
ing
and
Bill
ing
Acc
ura
te C
od
ing
and
Bill
ing
��B
ack
Bac
k--E
nd
wo
rk (
Co
llect
ion
s)E
nd
wo
rk (
Co
llect
ion
s)��
Bac
kB
ack--
En
d w
ork
(C
olle
ctio
ns)
En
d w
ork
(C
olle
ctio
ns)
��E
ffec
t O
per
atin
g E
ffic
ien
cyE
ffec
t O
per
atin
g E
ffic
ien
cy
Questions To Ask
Questions To Ask
��B
illin
g: D
on
e In
Bill
ing:
Do
ne
In--H
ouse
or
Outs
ourc
ed?
Ho
use
or
Outs
ourc
ed?
��D
on
e b
y C
erti
fied
Co
der
?D
on
e b
y C
erti
fied
Co
der
?
��D
o w
e h
ave
rele
van
t an
d a
ccura
te M
anag
emen
t D
o w
e h
ave
rele
van
t an
d a
ccura
te M
anag
emen
t R
epo
rts?
Rep
ort
s?R
epo
rts?
Rep
ort
s?
��F
inan
cial
Per
form
ance
Fin
anci
al P
erfo
rman
ce
��R
ecei
vab
les
Rec
eiva
ble
s
��E
ffic
ien
cy D
ata
Eff
icie
ncy
Dat
a
��B
ench
mar
kin
gB
ench
mar
kin
g
��Is
so
meo
ne
loo
kin
g at
th
em?
Is s
om
eon
e lo
oki
ng
at t
hem
?
Medical vs. Coding Terminology
Medical vs. Coding Terminology
Be Specific…..
Be Specific…..
��T
ho
raco
tom
y/T
ho
raco
sco
py
Th
ora
coto
my/
Th
ora
cosc
op
y
��(0
0540
) n
ot
spec
ifie
d(0
0540
) n
ot
spec
ifie
d12
BU
12 B
U
��(0
0541
) uti
lizin
g o
ne
lun
g ve
nti
lati
on
(0
0541
) uti
lizin
g o
ne
lun
g ve
nti
lati
on
15
BU
15 B
U
��K
nee
Art
hro
sco
py
Kn
ee A
rth
rosc
op
y��
Kn
ee A
rth
rosc
op
yK
nee
Art
hro
sco
py
��d
iagn
ost
ic
dia
gno
stic
3
BU
3 B
U
��su
rgic
alsu
rgic
al4
BU
4 B
U
��Sh
ould
er A
rth
rosc
op
y Sh
ould
er A
rth
rosc
op
y
��d
iagn
ost
icd
iagn
ost
ic4
BU
4 B
U
��su
rgic
alsu
rgic
al5
BU
5 B
U
Medical vs. Coding Terminology
Medical vs. Coding Terminology
Be Specific…..
Be Specific…..
��C
AB
G/
Mit
ral V
alve
Pro
ced
ure
sC
AB
G/
Mit
ral V
alve
Pro
ced
ure
s��
(005
62)
wit
h p
um
p o
xyge
nat
or
(005
62)
wit
h p
um
p o
xyge
nat
or
20 B
U20
BU
��(0
0566
) w
ith
out
pum
p o
xyge
nat
or
(005
66)
wit
ho
ut
pum
p o
xyge
nat
or
25 B
U25
BU
��C
ran
ioto
my
Cra
nio
tom
y��
(002
10)
Intr
acra
nia
l Pro
ced
ure
, no
t sp
ecif
ied
(002
10)
Intr
acra
nia
l Pro
ced
ure
, no
t sp
ecif
ied
11 B
U11
BU
��(0
0218
) In
trac
ran
ial P
roce
dure
, sit
tin
g p
osi
tio
n(0
0218
) In
trac
ran
ial P
roce
dure
, sit
tin
g p
osi
tio
n13
BU
13 B
U
Factors Affecting
Factors AffectingDepartment (Group)
Department (Group)
Financial Performance
Financial Performance
��P
ract
ice
Set
tin
g (L
oca
tio
n, S
pec
ialt
ies,
P
ract
ice
Set
tin
g (L
oca
tio
n, S
pec
ialt
ies,
Co
vera
ge r
equir
emen
ts)
Co
vera
ge r
equir
emen
ts)
��V
olu
me
Vo
lum
e
��O
per
atin
g R
oo
m E
ffic
ien
cyO
per
atin
g R
oo
m E
ffic
ien
cy
��C
ase
Mix
Cas
e M
ix
��P
ayer
Pay
er--M
ixM
ix
��P
ract
ice
Mo
del
Pra
ctic
e M
od
el
��R
even
ue
Rev
enue--
Cyc
leC
ycle
Billing Financial Metrics
Billing Financial Metrics
Understand the difference between Gross
Understand the difference between Gross
Charges, Reimbursement Rate and Net
Charges, Reimbursement Rate and Net
Revenue
Revenue
��O
ften
th
ese
thre
e n
um
ber
s ar
e use
d in
terc
han
geab
ly b
y O
ften
th
ese
thre
e n
um
ber
s ar
e use
d in
terc
han
geab
ly b
y ad
min
istr
ato
rsad
min
istr
ato
rsad
min
istr
ato
rsad
min
istr
ato
rs
��C
har
ges
(Gro
ss C
har
ges)
: Un
it R
ate
set
by
the
Pra
ctic
eC
har
ges
(Gro
ss C
har
ges)
: Un
it R
ate
set
by
the
Pra
ctic
e
��R
eim
burs
emen
t R
ate:
Un
it R
ate
Pay
er w
ill p
ay y
ou
Rei
mb
urs
emen
t R
ate:
Un
it R
ate
Pay
er w
ill p
ay y
ou
��N
et R
even
ue:
Act
ual
Mo
ney
Co
llect
edN
et R
even
ue:
Act
ual
Mo
ney
Co
llect
ed
��C
on
trac
tual
Wri
te O
ff :
Dif
fere
nce
bet
wee
n G
ross
C
on
trac
tual
Wri
te O
ff :
Dif
fere
nce
bet
wee
n G
ross
C
har
ge a
nd
co
ntr
acte
d R
eim
burs
emen
t R
ate
Ch
arge
an
d c
on
trac
ted
Rei
mb
urs
emen
t R
ate
Billing Financial Metrics
Billing Financial Metrics
��G
ross
Ch
arge
sG
ross
Ch
arge
s
��P
roce
dure
: Ven
tral
P
roce
dure
: Ven
tral
Her
nia
Rep
air
(008
32)
Her
nia
Rep
air
(008
32)
��B
ase
Un
its:
6B
ase
Un
its:
6
An
esth
esia
Tim
e: 6
An
esth
esia
Tim
e: 6
��R
eim
burs
emen
tR
eim
burs
emen
t
��P
roce
dure
: Ven
tral
P
roce
dure
: Ven
tral
Her
nia
Rep
air
(008
32)
Her
nia
Rep
air
(008
32)
��B
ase
Un
its:
6B
ase
Un
its:
6
An
esth
esia
Tim
e: 6
An
esth
esia
Tim
e: 6
��A
nes
thes
ia T
ime:
6A
nes
thes
ia T
ime:
6
��C
har
ge R
ate:
$72
.00
Ch
arge
Rat
e: $
72.0
0
��T
ota
l Ch
arge
: $72
.00
* (6
T
ota
l Ch
arge
: $72
.00
* (6
+ 6
) =
$86
4.00
+ 6
) =
$86
4.00
��A
nes
thes
ia T
ime:
6A
nes
thes
ia T
ime:
6
��M
edic
are
Rei
mb
urs
emen
t M
edic
are
Rei
mb
urs
emen
t
Rat
e: $
22.6
7R
ate:
$22
.67
��T
ota
l Pay
men
t: $
22.6
7 *
To
tal P
aym
ent:
$22
.67
*
(6 +
6)
= $
272.
04(6
+ 6
) =
$27
2.04
Co
ntr
actu
al W
rite
Off
= $
591.
96
Billing Financial Metrics
Billing Financial Metrics
Sho
uld
be
trac
ked
an
d r
evie
wed
mo
nth
ly in
ord
er
Sho
uld
be
trac
ked
an
d r
evie
wed
mo
nth
ly in
ord
er
to d
etec
t ea
rly
war
nin
g si
gns
of
pro
ble
ms
to d
etec
t ea
rly
war
nin
g si
gns
of
pro
ble
ms
��O
vera
ll A
cco
un
ts R
ecei
vab
le (
A/
R)
Ove
rall
Acc
oun
ts R
ecei
vab
le (
A/
R)
��O
vera
ll A
cco
un
ts R
ecei
vab
le (
A/
R)
Ove
rall
Acc
oun
ts R
ecei
vab
le (
A/
R)
��G
ross
Co
llect
ion
s R
atio
Gro
ss C
olle
ctio
ns
Rat
io
��A
/R
Agi
ng
Bre
akd
ow
nA
/R
Agi
ng
Bre
akd
ow
n
��N
et C
olle
ctio
n R
ate
Net
Co
llect
ion
Rat
e
Overall Accounts Receivable (A/R)
Overall Accounts Receivable (A/R)
Des
crib
es O
uts
tan
din
g G
ross
Ch
arge
sD
escr
ibes
Outs
tan
din
g G
ross
Ch
arge
s
��R
elev
ant
for
Tre
nd
ing
Pra
ctic
e A
ctiv
ity
Rel
evan
t fo
r T
ren
din
g P
ract
ice
Act
ivit
y
��N
ew T
ren
ds
war
ran
t fu
rth
er in
vest
igat
ion
New
Tre
nd
s w
arra
nt
furt
her
in
vest
igat
ion
��N
ew T
ren
ds
war
ran
t fu
rth
er in
vest
igat
ion
New
Tre
nd
s w
arra
nt
furt
her
in
vest
igat
ion
��C
ase
Vo
lum
e F
luct
uat
ion
sC
ase
Vo
lum
e F
luct
uat
ion
s
��C
olle
ctio
n P
rob
lem
sC
olle
ctio
n P
rob
lem
s
��C
har
ge R
ate
Ad
just
men
tC
har
ge R
ate
Ad
just
men
t
Gross Collections Ratio
Gross Collections Ratio
Des
crib
es N
et C
olle
ctio
ns
as a
Per
cen
tage
of
Gro
ss C
har
ges
Des
crib
es N
et C
olle
ctio
ns
as a
Per
cen
tage
of
Gro
ss C
har
ges
Net
Co
llect
ion
s *
100
Net
Co
llect
ion
s *
100
Gro
ss C
har
ges
Gro
ss C
har
ges
��V
arie
s fr
om
pra
ctic
e to
pra
ctic
e b
ased
on
Un
it c
har
ge R
ate
Var
ies
fro
m p
ract
ice
to p
ract
ice
bas
ed o
n U
nit
ch
arge
Rat
e ��
Var
ies
fro
m p
ract
ice
to p
ract
ice
bas
ed o
n U
nit
ch
arge
Rat
e V
arie
s fr
om
pra
ctic
e to
pra
ctic
e b
ased
on
Un
it c
har
ge R
ate
and
Pay
eran
d P
ayer
--Mix
Mix
��N
ew t
ren
ds:
Pay
or
New
tre
nd
s: P
ayo
r--M
ix c
han
ges,
“B
ack
Mix
ch
ange
s, “
Bac
k--en
d”
Co
llect
ion
en
d”
Co
llect
ion
ch
ange
sch
ange
s
��U
sefu
l in
pre
dic
tin
g fu
ture
cas
hU
sefu
l in
pre
dic
tin
g fu
ture
cas
h
��A
nes
thes
ia B
ench
mar
k:
An
esth
esia
Ben
chm
ark:
��
Mea
n: 4
4.7%
M
ean
: 44.
7%
��7575
ththP
erce
nti
le: 3
8.3%
Per
cen
tile
: 38.
3%(M
GM
A 2
007
Co
st S
urv
ey f
or
An
esth
esia
Rep
ort
)(M
GM
A 2
007
Co
st S
urv
ey f
or
An
esth
esia
Rep
ort
)
A/R Aging Breakdown
A/R Aging Breakdown
Cal
cula
tes
the
per
cen
tage
of
tota
l A
/R
in
C
alcu
late
s th
e p
erce
nta
ge o
f to
tal A
/R
in
ce
rtai
n a
gin
g ca
tego
ries
cert
ain
agi
ng
cate
gori
es
��M
easu
res
ho
w q
uic
kly
the
pra
ctic
e co
llect
s (o
r M
easu
res
ho
w q
uic
kly
the
pra
ctic
e co
llect
s (o
r re
solv
es)
Ch
arge
sre
solv
es)
Ch
arge
sre
solv
es)
Ch
arge
sre
solv
es)
Ch
arge
s
��Im
po
rtan
t in
dic
ato
r o
f b
illin
g an
d c
olle
ctio
n
Imp
ort
ant
ind
icat
or
of
bill
ing
and
co
llect
ion
p
erfo
rman
cep
erfo
rman
ce
��E
arly
war
nin
g si
gns
of
“new
” co
llect
ion
E
arly
war
nin
g si
gns
of
“new
” co
llect
ion
p
rob
lem
sp
rob
lem
s
��C
ateg
ori
es u
sefu
l to
ass
ess:
<30
day
s, 3
1 C
ateg
ori
es u
sefu
l to
ass
ess:
<30
day
s, 3
1 --
60
60
day
s, 6
1 d
ays,
61
--90
day
s, 9
1 90
day
s, 9
1 ––
120
day
s an
d >
120
day
s.12
0 d
ays
and
>12
0 d
ays.
A/R Aging Breakdown
A/R Aging Breakdown
An
esth
esia
Ben
chm
arks
:A
nes
thes
ia B
ench
mar
ks: M
ean
Mea
n7575
ththP
erce
nti
le
Per
cen
tile
��<
30 d
ays
<30
day
s53
.5%
53.5
%46
.4%
46.4
%
��31
31
--60
day
s60
day
s18
.4%
18.4
%13
.3%
13.3
%��
31
31 --
60 d
ays
60 d
ays
18.4
%18
.4%
13.3
%13
.3%
��61
61
--90
day
s90
day
s8.
4%8.
4%7.
2%7.
2%
��90
90
––12
0 d
ays
120
day
s5.
2%5.
2%4.
2%4.
2%
��>
120
day
s>
120
day
s14
.5%
14.5
%8.
35%
8.35
%
(MG
MA
200
7 C
ost
Surv
ey f
or
An
esth
esia
Rep
ort
)(M
GM
A 2
007
Co
st S
urv
ey f
or
An
esth
esia
Rep
ort
)
Resources
Resources
��M
edic
are:
M
edic
are:
ww
w.c
ms.
hh
s.go
vw
ww
.cm
s.h
hs.
gov
��A
AN
A:
AA
NA
: ww
w.a
ana.
com
ww
w.a
ana.
com
��A
SA:
ASA
: ww
w.a
sah
q.o
rgw
ww
.asa
hq.o
rg
��A
nes
thes
ia S
taff
ing
Co
nsu
ltan
ts:
An
esth
esia
Sta
ffin
g C
on
sult
ants
: w
ww
.ASC
on
sult
ants
.co
mw
ww
.ASC
on
sult
ants
.co
mw
ww
.ASC
on
sult
ants
.co
mw
ww
.ASC
on
sult
ants
.co
m
��A
nes
thes
ia A
nsw
er B
oo
k:
An
esth
esia
An
swer
Bo
ok:
ww
w.d
ecis
ion
hea
lth
.co
mw
ww
.dec
isio
nh
ealt
h.c
om
��St
ud
y G
uid
e fo
r A
nes
thes
ia C
od
ing
Cer
tifi
cati
on
St
ud
y G
uid
e fo
r A
nes
thes
ia C
od
ing
Cer
tifi
cati
on
w
ww
.med
ical
spec
ialit
yco
din
g.co
mw
ww
.med
ical
spec
ialit
yco
din
g.co
m
��Ji
m S
cars
ella
: Ji
m S
cars
ella
: jsc
arse
lla@
asco
nsu
ltan
ts.c
om
jsca
rsel
la@
asco
nsu
ltan
ts.c
om
Ques
tio
ns?
??Q
ues
tio
ns?
??Q
ues
tio
ns?
??Q
ues
tio
ns?
??
