POLICY 1

Billing Practices

BLOCK TIMES (blocks for post-op pain): 

Block Times must be listed on the billing ticket and anesthetic record or block note to get internal minutes (as Abeo cannot complete compliant billing without it).   It is best to have a block time before or after your Anes times.   If the block time overlaps the Anes time, then the overlapping time will not be given credit for billing, and reduced case minutes will be assigned by Abeo.   ALL blocks must state "PSR" (per surgeon request) on the block note or Anes record, and box checked PSR on billing ticket-  without this we cannot bill the block compliantly, and so will not assign minutes for the block.   

Ideal documentation:  Block Time Start:  0700 - 0711,   Anes start time AFTER 0711 (No overlap)

 

CLINICAL MINUTES

All minutes below must include documentation in the medical record a clinical / billable item-  Clinical justification for 2 or more blocks is essential as well (ie, cannot bill for "post-op pain management" both an epidural and a adductor catheter for a total knee case, as this is duplication of coverage and puts us at increased risk of audit.  If the epidural fails, then such could be considered with explanatory documentation).    

  • Single Block30
  • Nerve Catheter 30 (change on April 1, 2017 to 30 min, due to reduced collections), but  45 min for home catheter (ie, total ankle cases) 
  • 2nd Block- 50% of first
  • 3rd block- 0
  • Epidural 60 min (includes CSE, if spinal is for primary Anes, and epidural for post-op pain)
  • A-line 30
  • CVC line 60 
  • Post-op visit 15
  • Intrathecal injection 30 (only if no spinal done for primary anesthetic)  

 

ADMIN MINUTES

(non-billable internal minutes)

  • Recovery 30
  • Preop Calling 50/week
  • Preop Ryu calling 150/week
  • Ryu 60/day, 15/case
  • Meetings 60/mtg
  • Holiday  1st call 300,  2nd call 150  (for ONE day of the holiday weekend)-  New Year’s Day, President’s Day, Memorial Day, 4th of July, Labor Day, Thanksgiving Day, and Christmas Day.  
  • "in from home"  30/day, designates rare case of coming in to follow-up on an urgent post-op issue on a patient when not on call.  

Random audits will occur by group leadership, as well as reporting to the group Pres by Abeo for those Partners consistently ignoring these minute assignments-  the individual will be contacted by group leadership and a penalty for non-adherence may be instituted by the BOD.

 

ALL BILLING TICKETS MUST BE TURNED IN WITHIN 7 DAYS FROM THE DATE OF THE CASE.  Any late tickets (which are likely to delay collections for pooled reimbursement for the whole group) may incur a 150 minute penalty when 10 days late, and after 3 weeks no minutes for those cases will be assigned to that Anesthesiologist, and still must be turned in.  Exceptions may be made for the occaisional "lost ticket" but will not be honored where there is whole groups of tickets that are consistently turned in late.   This policy, along with others, to be reviewed at the next BOD and voted on.  

 

ASA STATUS modifiers on billing ticket:   if Patient is ASA 3 or greater, or E, there needs to be documentation in the chart AND on the billing ticket of patient conditions that qualify them for that ASA status or E status.  E (emergency) can only be billed if it "threatens life or limb" (ie., a typical hip fracture does not usually qualify as threatening life or limb unless compromising perfusion/nerve function, whereas an Appy routinely is, etc).   

POLICY 2

UNDER CONSTRUCTION

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POLICY 3

UNDER CONSTRUCTION

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