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medical billing

Fair Market Value for Anesthesia Practices

The notion of a fair market value (FMV) analysis is very common in real estate. The intent is to determine the price that a reasonable buyer should pay a qualified seller for a property. What does the concept have to do with anesthesia practices? The fact is that CMS guidelines require an FMV to ensure […]

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The Challenge of Anesthesia Charge Capture

In contrast to medical billing in the main, the submission of anesthesia claims in particular is uniquely intricate because of the multiple ways in which reimbursement is determined—starting with what’s found on the anesthesia record. While every other specialist dictates a narrative report describing the services provided to the patient, the anesthesia provider documents multiple […]

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Anesthesia Succession Planning: The New Old Challenge

Many anesthesia practices benefit from particularly strong leadership and management. Often, this is provided by an individual who is particularly well regarded by the membership and the medical community. Many practices put their trust in an individual who is qualified to guide the practice through the ever-evolving challenges of American medicine and speak for the […]

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They’re Watching: Federal Enforcement Actions Against Providers

Sometimes, you just get that nagging feeling. Somebody’s watching you. You look over your shoulder, but nobody’s there. That doesn’t mean, however, that you’re not, in fact, under some form of surreptitious surveillance. Medical providers would do well to proceed under the assumption that they are always under the microscope. If it’s not an auditor […]

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D.C. Deletes Non-Competes: FTC Issues Landmark Ruling

Many of us have been there.  We seek and land a great job, but there’s just one catch.  To lock up the position, we must first sign away our future right to seek employment in the same industry, up to a certain period of time (two years is standard), should we ultimately part ways with […]

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Battling the Onslaught: Strategies to Conquer Healthcare Staffing Shortages in 2024 

The healthcare industry remains on the front lines of a relentless battle – the war for talent. Staffing shortages, a pre-pandemic concern, have morphed into a full-blown crisis, threatening patient care, staff well-being, and organizational stability. From harried emergency rooms to understaffed nursing homes, the strain is undeniable.  A Deeper Dive: Why We’re Here  While […]

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2025 IPPS Proposed Rule: Quality Programs for Hospitals

Last week, we brought you a summation of the key provisions in the Medicare Inpatient Prospective Payment System (IPPS) proposed rule for fiscal year (FY) 2025. Today’s article will focus on the quality programs that concern the inpatient setting. Hospitals that do not submit quality data or do not meet all Hospital Inpatient Quality Reporting […]

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BCBS To Discontinue Physical Status Payments

Last week, we sent out a special alert advising our readers of a change in Aetna’s payment policy in connection with physical status (PS) modifiers on anesthesia claims. The payer announced it would no longer provide additional payment for PS 3-5, effective July 15 of this year. Not to be outdone, several of the “Blues” […]

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Aetna to Stop Physical Status Payments

According to an April bulletin published by Aetna, the payer will no longer reimburse additional unit value(s) for anesthesia physical status (PS) modifiers, effective July 15, 2024. Aetna gave as a reason for the decision its desire to align with similar Medicare guidelines. It should be noted that this change will only affect Aetna’s commercial […]

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