Week 7 - Business of Anesthesia Flashcards
What are the different types of payers for anesthesia services?
- Medicare (over 65, plus dialysis and some disability)
- Private Insurance (employer based, privately purchased, state exchanges)
- Medicaid (those w/o funds)
- Tricare (government employees)
- Patients (self-pay)
- Others such as worker’s comp
What are base units for billing Medicare?
Preop eval
Intraop base
Postop visit
- ALL activities MUST be completed or you can’t bill the base units
- base units come from ASA relative value guide (annual)
What are time units for billing Medicare?
One unit for every 15 minutes of contact time intraoperatively
*report time in minutes and Medicare will round – DON’T round yourself
What is a conversion factor for billing Medicare?
Medicare factor to convert the total number of units to money
*different conversion factors all over the country – decided annually
What is the equation to calculate payment for anesthesia services base when given the time for the case and the conversion factor?
(Base units + Time units) x Conversion Factor = $$$
ex: 6 base units + 60 min case (4 time untis) x $21 CF = $210 fee
What is a relative value unit?
value of starting baseline for a particular case – determines the base units
-computer program do it automatically based on numeric procedure codes placed in the billing program
What are the meaning of the following Medicare billing codes?
-AA, AD, QY, QK, GC, QX, and QZ
AA: anesthesia performed by MD
AD: medical supervision by MD >4 concurrent procedures
QY: medical direction of 1 CRNA
QK: medical direction of 2,3,4 concurrent procedures
GC: anesthesia performed by a resident under direction of a teaching physician
QX: anesthesia performed by a medically directed CRNA
QZ: anesthesia performed by a CRNA w/o direction or supervision
What are the Medicare billing modifiers?
Physical Status (ASA score):
- 1,2,6 = no modifier
- 3 = 1 addition unit
- 4 = 2 additional units
- 5 = 3 additional units
- Emergency = 2 units
Age <1 or >70 = 1 additional unit
Planned hypothermia = 5 untis
Planned hypotension = 5 units
What are the seven core principles of economic in healthcare?
- The Scarcity Principle
- The Cost-Benefit Principle
- The Principle of Unequal Costs
- The Principle of Comparative Advantage
- The Principle of Increasing Opportunity Cost
- The Equilibrium Principle
- The Efficiency Principle
What is the scarcity principle?
Having more of one good thing usually means having less of something else
What is the cost-benefit principle?
Take no action unless its marginal benefit is at least as great as its marginal cost
What is the principle of unequal costs?
some costs (marginal and opportunity) matter in decision making while others (sunk and average) don’t
What is the principle of comparative advantage?
everyone does best when each concentrates on the activity for which he or she is relatively most productive
What is the principle of increasing opportunity cost?
use the resources with the lowest opportunity cost before turning to those with higher opportunity costs
What is the equilibrium principle?
A market in equilibrium leaves no unexploited opportunities for individuals, BUT may not exploit all gains achievable through collective action
