Four Important Medicare Updates for Anesthesiologists

1. Medicare Payment Cut?the following:
Today, June 1st, is the date that the 21.2 percent un-- Scope of Anesthesia Services Policy
Sustainable Growth Rate (SGR) reduction in Medicare- Director of Anesthesia Services Policy
payments to physicians is going to go into effect.- Policies and Procedures Governing Anesthesia
Once again Congress is trying to pass legislation thatPrivileging in Hospitals
will give physicians a very small increase for now and- Pre Anesthesia Evaluation Policy
defer solving the SGR problem until a later date –- Pre Anesthesia Evaluation Note
2014, under the American Jobs and Closing Tax- CMS Pre Anesthesia Evaluation Form
Loopholes Act of 2010 (H.R. 4213). The Senate- Intraoperative Anesthesia Record Policy
adjourned without taking up the bill, however; it will- Post Anesthesia Evaluation Policy
return on June 7th.- Post Anesthesia Evaluation Note
As has happened each time that we've approached- CMS Post Anesthesia Evaluation Form
the deadline before, CMS has announced that it will3. CMS Makes Small Adjustments to PQRI Bonus
hold claims for services provided on the effective datePayments for 2008
of the cut and during the following nine business days,So many physicians questioned the amount of the
to give Congress time to pass the legislation thatbonuses they received for successfully participating in
would postpone the SGR cut. This time claims will bethe 2008 PQRI program that CMY took a careful look
held through June 14th.and identified inaccuracies in counting claims submitted
On Thursday May 27th, CMS sent out the followingfor reconsideration or on which Medicare was a
notice on its physician payment listserv:secondary payer.  In its notice, CMS said, "Although
The Continuing Extension Act of 2010, enacted on Aprilthe amount of the inaccuracy was overall small, it
15, 2010, extended the zero percent (0%) update toaffected a large portion of eligible professionals who
the 2010 Medicare Physician Fee Schedule (MPFS)satisfactorily reported for 2008 PQRI. In the vast
through May 31, 2010.  The Centers for Medicaremajority of cases the resultant incentive payment
& Medicaid Services (CMS) believes Congress isadjustment is very small."
working to avert the negative update scheduled toAlso according to the CMS notice, the Medicare
take effect June 1, 2010.  To avoid disruption in thecontractors should have finished processing the
delivery of health care services to beneficiaries andadjusted payments by May 21st.  You will be able to
payment of claims for physicians, non-physicianrecognize any such adjusted PQRI incentive payment
practitioners, and other providers of services paidby specific language on paper checks.  "If you
under the MPFS, CMS has instructed its contractors toreceive electronic remittances, look for provider
hold claims containing services paid under the MPFSadjustment reason code "LE" in the PLB 03-1 segment,
(including anesthesia services) for the first 10 businessand PQ08 in the PLB 03-2 segment, on the 835P to
days of June.  This hold will only affect MPFS claimsalert you that the incentive adjustment payment is for
with dates of service June 1, 2010, and later.the 2008 PQRI. (The monetary amount will be in the
This hold should have minimum impact on providerPLB04 segment of the 835P."
cash flow because, under the current law, cleanFinally, CMS indicates that it plans to publish a 2008
electronic claims are not paid any sooner than 14experience report that "will detail the program results
calendar days (29 for paper claims) after the date offor 2008 including results of the inquiry process."
receipt.4. The June 1st Deadline for Compliance with the Red
2. More CMS Clarifications to the Hospital InterpretiveFlag Rules is Postponed Again
Guidelines for Anesthesia ServicesJune 1st was to have been the final deadline
Our May 10 Alert discussed the December 2009 andfor physicians and other entities that extend credit (by
February 2010 revisions to the anesthesia servicesproviding services and then billing the patient) to
section of the Interpretive Guidelines that elaborate oncomply with the Federal Trade Commission's "Red
the Medicare Conditions of Participation for hospitals. Flag Rules," which require the implementation of identity
Many readers are by now quite familiar with thetheft prevention programs.
difficulties created by the rewrite of these InterpretiveThe FTC announced on May 28th, however, that it
Guidelines.  We indicated in the hyperlinked Alert thatwould extend the deadline again, this time until
ASA was seeking to have CMS correct some of theDecember 31, 2010. Several Members of Congress
more problematic innovations.  The conversationshad requested the delay because the Senate has still
between ASA and CMS have begun to bear fruit.  Innot taken action on legislation that would exempt some
a May 21st update to the Interpretive Guidelinesbusinesses from the Red Flag Rules. (The bill, H.R.
manual. CMS made the following important changes:3763, passed unanimously in the House of
- The supervising anesthesiologist is "immediatelyRepresentatives in October 2009.)
available" if in the same procedure suite or L&DThe identity theft programs mandated by the Red Flag
suite. In states that have not opted out of the ConditionRule are scalable to the nature and size of the
of Participation requiring supervision of nurseorganization.  They must include "reasonable" policies
anesthetists, the hospital Interpretive Guidelines (as welland procedures to identify relevant Red Flags that
as the anesthesia medical direction payment rules,could signal problems, to detect Red Flag incidents and
independently) require that the anesthesiologist beto respond appropriately to any Red Flags that are in
"immediately available" while supervising CRNAs orfact detected.
AAs.  The earlier version of the Interpretive GuidelinesThe compliance deadline was originally November 1,
spoke of being in the same labor and delivery unit, or in2008.  It has now been delayed five times as a
the same procedure room."result of lobbying by various interests including
- For outpatient surgery, the post-anesthesia evaluationorganized medicine, which objected to the inclusion of
does not need to be completed before discharge. Itphysicians among the "creditors" covered by the Red
must still be completed within 48 hours from the timeFlag Rules. The AMA, together with the American
that the patient arrives in the recovery area.Osteopathic Association and the Medical Society of
The announcement of these clarifications on the ASAthe District of Columbia filed a lawsuit on May 21st to
website concludes with the statement: "According toblock the application of the Rule to physicians.
an Agency official, this transmittal represents a minor,We all hope that the lawsuit will succeed and that
preliminary clarification. Hence, further clarification fromphysicians will be exempted from this regulatory
future transmittals may be forthcoming. ASA willburden, which strikes some of us as coming from left
continue to work with CMS to address ongoingfield (if not the bleachers).  Meanwhile, though, like the
concerns."AMA et al., we are advising compliance if and when
Note that an ASA ad hoc committee has created anthe Rules finally do become effective, and we will
unofficial set of templates and resources to helpassist our clients in meeting the Red Flag Rule
anesthesiology departments comply with therequirements with as little disruption as possible.
Interpretive Guidelines and thus be better prepared forYou may expect to read more on all of these
the next TJC survey. The set, which is available on thesubjects as they evolve.  We hope that today's
Members-only page on the ASA website and whichupdate has been useful to you.
does not necessarily represent ASA policy, includes