Questions and Answers

Some healthcare providers will ask me if their practice really requires the expertise that BCS puts forth for each group we manage. My response is absolutely, "YES" for a variety of very important reasons. Like the analogy of peeling the onion, as you look at the surface you will identify certain aspects of what needs to be addressed for success, but as you look at each subsequent layer you will find that each layer is interrelated to other layers or components and therefore is absolutely necessary for your practice's success. Each aspect of the Practice Management Services of BCS are essentially designed to work together to achieve your practice's maximum result. For example, you must make certain you have a contractual stipulation with your place of service to access patient information; both clinical and demographic in nature, while incurring no increased costs. It is critical to create your charges in a compliant manner which is clearly identifiable and consistent. Further, a robust understanding of your payer mix and its financial impact on your practice is key, but you must also keep in mind that various payers have a multitude of product offerings with varying levels of reimbursement for your practice. You must realize that changes in the payermix can detract or enhance a practice's financial viability practically overnight, therefore very close monitoring of all practice data is essential. You must check, check, and re-check your practice's performance, its documentation, and its overall results. You must be vigilant in maintaining a compliant environment, you cannot assume payers will process your claims as they are contracted to do. You must maintain a compliant level of communication with your payer and patient community to maximize your practice's cashflow and AR performance all while closely monitoring and nurturing your relationship with your place of service (hospital, ASC, office setting) and your surgeons. You must utilize the expertise of certified and accredited health information (HIM) professionals for all procedure coding and diagnostic coding. You must have the necessary expertise to challenge claim denials, reductions, and negotiations, and also be prepared for any post processing/payment auditing. As you can see, the process is very complex and quite interrelated and this is only a partial listing of the expertise and resources that BCS puts forth each day for every practice we manage. Expertise that is quite complex, comprehensive, detailed, accurate, and ever so important, timely. Consider the BCS experience for your practice today. Better yet, ask BCS President, Lee S. Broadston to provide you with a confidential reference listing of clientele who already have experienced what we refer to as the “BCS Experience.” Contacting me is simple, just send me an email at Lee@BCSConsult.com I look forward to speaking with you.

Because your practice must succeed and BCS has a 30+ year track record of success and proven results! Measureable results in very short periods of time, Increase your cash flow, far faster AR turnaround - i.e. low AR Days 28-30 in most instances, your own personal Practice Consulting expert available to you at no additional cost, Coding-HIM Expertise - available to you again at no additional cost who are nationally certified experts and available to your practice - RHIA, CPC, CANPC, CIRCC, RHIT. BCS can attain electronic interaction with virtuallly any EMR, access, interpret and manipulate for your practice's benefit your practice information, patient information and communication. BCS will interact with your various places of service, BCS will handle all payer and patient interaction resulting in maximization of all available reimbursement. BCS leaves you with the objective of providing and delivering an excellent anesthetic for all patients. Contact Lee S. Broadston, BCS President today to find your rapid solution 888-278-4124 or Lee@BCSConsult.com

BCS has become involved in countless practices that are struggling in numerous areas of their operation. These are excellent practice opportunities but seriously struuggling financially. At no upfront cost to the practice, BCS can immediately implement our Practice Management Services as quickly as 1 day and turn these practices around in a just a few weeks. BCS has the available resources to IMMEDIATELY implement our operations for your practice. This means retrieving, coding, billing, and submitting months of backlogged charges and avoiding timely filing denials --doing so in a matter of just a few days. BCS has processed thousands of back logged charges for existing clientele resulting is vast surges in cash flow for these practices. Contact Senior Healthcare Practice Consultant and BCS President, Lee S. Broadston today Lee@BCSConsult.com to implement BCS's Healthcare Practice Management Services for your practice in just a few days. Quite literally, BCS could be operational for your practice tomorrow. The BCS experience translates into immediate practice implementation and results.

BCS has worked with literally thousands of healthcare providers, anesthesia, surgery, pathology, etc in addressing all of the necessary practice implementation details that must be addressed in order to achieve success. From coverage agreements, fiscal performance evaluations, practice/patient electronic data retrieval processes as well as their design to establishing and contracting your practice with the local payer community, BCS addresses each aspect. BCS has more than 30 years of practice implementation experience in all practice settings, rural, urban, hospital/facility based as well as true private practice. Success is being prepared, and BCS will make certain your practice is prepared, if we have 2 days or 60 days or more to implement we can get to work for you immediately and will do so at no upfront costs to you. We will not leave important details for you to figure out, but we will address each and every asepct of operation that needs attention in order to achieve the single primary goal, Your Practice's Success and the maximization of all available reimbursement. Contact BCS today and BCS will be working for you tomorrow! Contact BCS President, Lee S. Broadston via email at Lee@BCSConsult.com or voice at 888-278-4124. The BCS Experience ... immediate implementaiton and results.

All providers and their business office / administrative staff should already be aware of this upcoming change, but please be advised that Medicare ID cards and the beneficiary's ID numbers are changing starting in April 2018. Medicare will be mailing out new Medicare ID cards for all existing Medicare members starting in April 2018 and continuing for quite some time. An important note - The old Medicare ID and a newly assigned Medicare ID will both be accepted by the Medicare claims processing system at this time. At a point in the future that will NOT be the case and only the new ID numbers will be accepted. An example of what the new Medicare ID cards will look like and additional information about the new ID cards and the new ID numbers and the number's format can be viewed at : https://www.medicare.gov/forms-help-and-resources/your-medicare-card.html Most importantly all practice administrative staff need to be aware that the new Medicare ID numbers will have nothing to do with the patient's social security ID number or their spouse's social security ID number as it has in the past. The new Medicare ID numbers will require some patient accounting and software systems to be updated to accept the numbers in both their current format and the new format since the roll out of the new number assignment will take a while. Providers need to make certain their various software systems and their billing companies are able to accept and process claims with the new ID number and format. Medicare beneficiaries have been advised that healthcare providers and institutions will need to see their new Medicare ID card and therefore they have been advised to be prepared to provide the card to all healthcare providers when requested. BCS has been compliant with this new format for quite a while. BCS is prepared for this upcoming change

Your preparedness for the practice's implementaion is the key response to this question. BCS has decades of experience implementing new practices from the "ground up." Each of our clientele's practices, are essentially business entities that require detailed preparedness in order to achieve the success BCS and you expect. The general answer to this question is any where from 30-120 days from the date of your first billable anesthesia service. There are however, multiple circumstances that will impact this cash flow development timeline. The greatest impact will come from your preparedness in completing all that is necessary to credential, enroll, and contract - generally in that order - with each managed care entity that makes up the payermix of your practice. Your place of servivce shoudl be able to clearly provide to you the payermix data and then it is up to BCS to work with each payer to complete the necessary steps to reach a participating, contracted, in network status within your marketplace. Planning for practice implementation can not be stressed more. A rule of thumb used by BCS is that we need to allow for at least 90 days for the contracted managed care payers to process all of the group’s provider’s credentials and set the group / providers up as participating with a particular managed care plan. This 90 day timeline starts once the carrier receives all of the group/provider’s credentials. Also keep in mind that although many payers will require each provider to provide access to their current CAQH file, the CAQH file access process is only a ONE STEP in the multi-stepped process required to achieve the desire in network status. Remember retroactive billing after participation is granted is generally not allowed. Anesthesia services provided prior to your group’s effective participation date will more than likely be uncollectable.

CRNAs are considered an eligible professional (EPs) under the MIPS (Merit Based Incentive Payment System) program. There are certain exclusions for EPs. The most obvious is the Medicare reimbursement threshold set for 2017 of $30,000 in annual reimbursement from the Federal Medicare part B program. As we near the end of the 2017 MIPS reporting year, you should also be nearing the end of your reporting period. Next year’s Medicare reimbursement per provider threshold is $90,000 which means that some, not all, CRNAs may be excluded from the reporting requirement. BCS has developed web based applications that are compatible not only with smart devices/phones but also with tablets and PCs. BCS MIPS 2017 has been provided at NO COST to all BCS clientele. The applications allow our clientele to access their customized 2017 MIPS Measurement selections, quickly and easily record the appropriate responses for each of their selected measures and then BCS information systems combines the measurement data with the patient demographic data for submission to the QCDR/Registry. The BCS 2017 MIPS reporting process overall has thus far been quite successful. The 2018 MIPS reporting program at BCS is expected to follow the same detailed and customized process for those practices that qualify and wish to report. For further information about BCS’s support services for MIPS reporting and Contact Lee S. Broadston, ABA, COB -President (Lee@BCSConsult.com) or Missy Heuer, CPC, CANPC (MissyH@BCSConsult.com) of BCS today.

Yes, CRNAs are considered an eligible professional (EPs) under the MIPS program. There are certain exclusions for EPs. The most obvious is the Medicare reimbursement threshold set for 2017 of $30,000 in annual reimbursement from the Federal Medicare part B program.

Yes. BCS has developed web based applications that are compatible not only with smart devices/phones but also with tablets and PCs. BCS MIPS 2017 is provided at NO COST to all BCS clientele which allows our clientele to access their customized 2017 MIPS Measurement selections and quickly and easily record the appropriate responses for each of their selected measures. Contact Lee S. Broadston of BCS to enroll today.

BCS's newest information system's module, BCS Quality Measurement and Management Module is part of our comprehensive PASSAdvance information system. Not only are you able to upload your quality measurement data 24/7 to BCS's information systems via the conveniece of your smart device, PC, or Tablet, you can also request BCS to create your customized 2017 MIPS Measurement Reporting tool. If you prefer, you can easily complete your measurement tool document and fax / scan it to BCS along with your case data. This is yet another example of BCS's customization of services to meet each client's needs and expectations. Contact BCS today to receive your customized 2017 MIPS Measurement Reporting tool today via email.

Depending upon the location of your office based practice - local and state licensing laws- you should be able to provide anesthesia in an office setting. It is very important when looking at any anesthesia practice opportunity that you obtain a payer listing that lists all the payers associated with the practice. When speaking with the payers about becoming an in network provider, you need to verify that the payer will recognize your services in the office setting.

No, you should not commence to bill for your professional -or should your employer- anesthesia services until you have taken and passed your certification examination. The National Committee for Quality Assurance (NCQA) requires all participating providers to be properly certified and licensed within their specialty prior to granting a participating status. Therefore, often times new graduates will have the date of their certification examination as their effective date of participation. The only exception here would be with the Federal Medicare Program. In some states depending upon state by state laws, Medicare will setup your Medicare participation date prior to your certification examination date. A qualified anesthetist is one that is prepared and ready to sit for, or has completed the proper accreditation examination.

To properly evaluate a potential anesthesia practice for private practice, or for employment salary package negotiations you should ask to see a period of practice reports that outline the following clinical data elements: Total number of surgical cases performed that required anesthesia, a break down of the different types of surgical procedures such as a percentage of orthopedic, general surgery, urology, ophthalmology, and OB procedures. Understand how anesthesia is currently being provided/delivered -anesthesia care team, solo anesthetist, solo anesthesiologist, group practice of providers, individual providers, etc. Total number of operating rooms utilizing anesthesia, requirements if any for anesthesia to be present in the GI / Endoscopy lab, and OB requirements and involvement in labor pain management. In addition to this clinical data, demographic/patient accounting data should also be provided and include items such as a listing of managed care plans the facility is associated with, patient volumes by payer or an overall payermix, as well as identifying if any package pricing that currently includes anesthesia professional services is in force. Such an agreement would preclude you from separately billing a payer for your professional services.

Anesthesia providers maximize their revenue when they are providing anesthesia services, not when they are attempting to determine which CPT-4 or which ICD9-CM code(s) are appropriate. The process of reviewing, selecting, and / or determining the appropriate procedure and diagnosis codes is an entire profession in itself. Health Information Managers -(HIM), Registered Health Information Administrators (RHIA), Certified Coding Specialists (CCS), Certified Coding Specialists-Anesthesia (CCS-ANES), and Accredited Records Technicians (ART) are all credentialed professionals designed to assure compliance and consistency within the coding process. The HIM staff at BCS includes RHIAs, HIMs, CCS, CCS-ANES, COB, and CCS-PAIN who are members of our HIM -Health Information Management- staff. Each of these accredited and certified specialties are involved in multiple aspects of day to day operations at BCS. From a compliance standpoint only these types of properly certified and accredited individuals should be selecting and assigning CPT-4 and ICD9-CM codes and medical review and appeal procedures. Since reimbursement and many aspects of compliance are directly related to the code(s) selected, it is imperative that the code selection be correct in order to be within compliance with Medicare and the correct coding initiatives, but also to avoid overcharging or inappropriate charges for services rendered. It is best to select a management service to handle these critical areas of non-clinical practice operation all of whom must be involve these certified and accredited specialists.

Absolutely. For a number of reasons a Anesthesia Coverage Agreement is critical to your success. It not only outlines the responsibilities you have in providing anesthesia coverage for the facility/hospital, but it also outlines who you are, how you plan to provide service, sets forth the facts on how you are to be reimbursed for your services, direct billing to patients and their third party carriers, or a salary scheme directly with the facility. If your anesthesia practice allows you to directly bill your patients and / or their third party payers for your services there are a number of additional items that this type of agreement should cover. Examples of these items are allowance of access -free of charge- to all medical record documents necessary for billing and claim submission purposes, access to patient demographic and insurance data, as well as a clear indicator that you are not an employee of the facility/hospital nor are you involved in any aspect of the facility/hospital’s billing for any anesthesia supplies and / or equipment. Of course any legal binding contract should be reviewed by an attorney; however, several of the necessary issues that need to be addressed within the actual contract are missed by attorneys who’s primary concern is the legal interpretation of the agreement. Issues associated with HIPAA need to be addressed and you may be asked to sign a Business Associates agreement with the hospital/facility.

This is an excellent 'opener' at a meeting with facility administration for any department head of an anesthesia department when the topic of anesthesia revenue comes up. Professional services in the anesthesia department may well be the only department within the facility that potentially has untapped revenue available for today's educated and 'street smart' healthcare administrator. I say 'street smart' because today's effective healthcare administrator needs to think entirely 'out of the box' to develop methods of efficiency and revenue enhancement and identification that have not been previously tried and tested within today's healthcare marketplace. Professional services revenue is available to anyone that employs or contracts with anesthesia providers whether physician or CRNA. Another 'out of the box' theory is to grasp professional services revenue and own it, manage it, measure it, and control it so that the employer or contractor of the anesthesia group is in control of the economic drivers that are present within the marketplace for anesthesia. Only then will the 'street smart' healthcare executive maintain the ability to state that they are maximizing their CRNA reimbursement.

In order to determine if your facility can answer this question in the affirmative, you will need to essentially dismantle the anesthesia professional fees within your facility and analyze the current methodology that is in place. The duration or total anesthesia time is only one element of this puzzle and if time is the only element utilized within your institution then financial losses are imminent. BCS has designed our Anesthesia Practice Impact Study process to do just this identify current revenue generators, breakdown their methodology, compare and contrast to industry standards, and layout the changes that are needed to make certain you can affirmatively answer the question, "How are we certain we are maximizing CRNA reimbursement."

A provider should ask a patient to complete and execute an ABN if the provider of anesthesia services believes the anesthesia service may not be covered by Medicare for a number of reasons. There are strict rules and regulations pertaining to the utilization of an ABN and its submission to Medicare. The use of the ABN legally allows you to bill the Medicare Beneficiary for the non-covered services following your submission of all documents to Medicare. If the services are denied by Medicare as non-covered then you will commence to bill the patient and/or their secondary payer for the full usual and customary fee for the service. It is important to note that you should never discount your charges for any patient for any reason.

CRNAs as well as physicians are required to apply for an obtain an National Provider Identifier or NPI. The deadline for obtaining and being using an NPI was May 23, 2007; however, CMS -the Centers for Medicare and Medicaid- has launched an extension of this deadline referred to as their contingency plan. Even under the contingency plan you should have your NPI by now, but if you do not, you need to access the NPI Enumerator's website and apply for it. It is easy, it is quick, and it is required. You will find the NPI Enumerator's site at https://nppes.cms.hhs.gov

If you fail to obtain an NPI and submit your NPI as required to all third party payers, your claims for reimbursement will be denied. It is critical to your practice's success to make certain that all NPI claim preparation requirements are in place within your practice. Do this today, not tomorrow, not next week, but today. If you work with an outsourced billing organization they should be well aware of the NPI requirements and should easily be able to verify that all NPI requirements are in place for your claims processing system.

Yes. NPIs are issued to individual providers and also to each entity or group that bills for the services of their providers. Therefore, you will have a group NPI that ties back to your group entity, as well as an individual NPI that ties back only to you. You will not be allowed to apply for an receive more than one individual provider NPI . If you do apply for an NPI and the system denies you an NPI due to the fact that one has already been established for you, you need to contact the enumerator and ask to speak with an NPI Specialist to identify what your NPI is and who applied for it on your behalf

The most favored nation clause in a third party payer contract simply means that you agree not to charge other payers -this would include patients- a lesser charge for your services than you charge the payer you are contracting with. If you do, the payer you are contracting with may be able to retroactively review your previous claim data and determine that you were utilizing a lower fee schedule for other payers and because of a most favored nation clause, the carrier could potentially seek to recoup dollars paid to you that were over and above any lesser fee schedule your practice may have had in place. This clause is fairly common language in most reimbursement and participation agreements; therefore it will be nearly impossible to negotiate out of the agreement. Best advice is to always create your professional charge on the same basis for all services provided regardless of the third party payer that may be involved. From a compliance standpoint it is the only way to go.

An RFP is a formal Request for Proposal, usually submitted to a vendor or provider of service by an organization who is seeking bids for such service. In the business of anesthesia you may often hear a hospital say "...they have sent out an RFP or that project went out on RFP.." this means that they are simply soliciting organizations to submit a proposal and in the world of anesthesia this would mean an anesthesia services proposal. If you are the recipient of an RFP, you need to read over all the details outlined in the RFP document and then decide if you or your organization is going to prepare a response to this RFP. If so, you will need to prepare a detailed response that answers all the questions within the RFP, plus provide a detailed outline of your organization, the type of anesthesia services you provide, the resources you have in place and/or would put in place, to provide these services, your background academically and clinically, and how you perceived carrying out the duties of the contract should your proposal be accepted. Often times vendors do not know ahead of time that they are being considered for an RFP opportunity. BCS's weekend educational seminar entitled, "The Business of Today's Anesthesia Practice" has devoted a 60 minute session to this overall process detailing what an RFP is, how should a response be prepared, by whom and when. This session has been received very well by the attendees.

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.

It certainly does need to be used. The modifiers that are set forth by the Federal Medicare for use with anesthesia services are extremely important and must always be utilized. When preparing anesthesia charges for submission to Medicare or any other payer, there are several modifier choices to consider, AA, QK, QY, QX, QZ, QS. These modifiers indicate important aspects of the anesthesia administration such as what specialty is the provider -physician anesthesiologist or a Certified Registered Nurse Anesthetist, whether or not the CRNA is being Medically Directed by an anesthesiologist, and / or whether or not the case involves the anesthetic administration technique referred to as Monitor Anesthesia Care or MAC. Whomever is handling the coding and billing should be completely aware and intimately familiar with these modifiers and the proper use of them.