Q. Does it make any difference if I select CPT-4 codes from the Surgical or Anesthesia Sections?

A. Yes. In the past -pre HIPAA days- many payers-and some still do as they do not comply with HIPAA requirements- required different CPT codes from different sections of CPT for anesthesia claim preparation. Following the implementation of the requirement of HIPAA on October 16, 2003, all anesthesia services are to be billed using only the Anesthesia Codes within CPT-4. If you use a code from the surgical section of CPT4 the payer may become confused and actually believe that you are billing for surgical services and not anesthesia services. Understanding what the payers in your particular practice require for claim submission is essential. Furthermore, anesthesia practice management is further complicated by the varying nature of the professional fees due to the factor of time in the calculation. Unlike other medical services provided by other medical professionals, anesthesia professional fees vary because the length of time the anesthesia is administered is a component within the charge structure itself. Therefore understanding a payer’s requirement for the reporting of anesthesia time is essential for proper claim submission as well.

Q. How are we certain we are maximizing CRNA reimbursement within our facility?

See Answer.

Q. What is the necessity of obtaining an NPI -National Provider Identifier?

See Answer.

Q. Does an entity as well as an individual provider need an NPI?

See Answer.

Q. What does the term "most favored nation" mean as it appears in many third party payer reimbursement agreements and participation agreements?

See Answer.

Q. What is an RFP?

See Answer.

Q. Does it make any difference if I select CPT-4 codes from the Surgical or Anesthesia Sections?

See Answer.

Q. Since the Medicare Modifier -QS is not valid for actual reimbursement calculation, does it really need to be used?

See Answer.

Q. How long will it take to develop a cash flow from a new practice opportunity?

See Answer.

Q. I have graduated from Anesthesia School, but have not taken my certification examination, can I still bill for my services since I have completed my required anesthesia program?

See Answer.

Q. In evaluating a practice opportunity what questions or data should I be requesting from the practice?

See Answer.

Q. I plan to do all of my own procedure and diagnosis coding, -CPT-4 and ICD9-CM coding) is this a good idea?

See Answer.

Q. Is it necessary to have type of contract with a facility/hospital before I commence providing anesthesia services?

See Answer.

Q. Why would I use an ABN-Medicare Beneficiary Advance Benefit Notification document?

See Answer.

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