Anesthesia Billed Time Units - BCBS NY

[sloh]

“Beginning with claims processed on or after February 1, 2025, Anthem will change how it evaluates billed time on professional claims for anesthesia services (that is, CPT codes 00100 through 01999).

We will utilize the CMS Physician Work Time values to target the number of minutes reported for anesthesia services. Claims submitted with reported time above the established number of minutes will be denied. This update will not change industry standard coding requirements or the American Society of Anesthesiologists’ (ASA) anesthesia formula.

This update will account for anesthesia work time included in the pre-service evaluations, intra-service period, and post-service period. The appropriateness of billing for pre- and post-operation time must be documented and follow the guidelines established by the ASA as to the appropriate time that should be counted and documented.”

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[aneftp]

Depends how much you are billing for pre and post time.

 

[aneftp]

https://www.asahq.org/-/media/sites/asahq/files/public/advocacy/alerts/asa_qualifyingcircumstances-anthemletter--10-02-202.pdf

 

[sloh]

https://www.asahq.org/-/media/sites/asahq/files/public/advocacy/alerts/asa_qualifyingcircumstances-anthemletter--10-02-202.pdf

Did they respond?

 

[DirtDocMD]

“This update will account for anesthesia work time included in the pre-service evaluations, intra-service period, and post-service period.”



“Work time” in the “Intra-service period”???

So they’re gonna “account” for the surgeons who can’t do cases in a reasonable amount of time??

Whether they want to acknowledge it, or not, a 4-hour case costs insurance/patient way more than a 2-hour case. I’ve seen reports of $3000 an hour (and some significantly more) for “OR time”.

Seriously, with “OR time”/facility fees being WAY higher than any charges for “anesthesia”, when are they gonna start auditing SURGEONS who are taking 2-3x as long as their average colleagues, to do the “same” case???

 

[A Deep Breath]

The slow surgeons already get punished since they make the same regardless of how long the case takes.

 

[aneftp]

How much preop and post op time are being billing. That seems to be the crux of this. $100 here and there adds up quickly.

 

[crna2006]

How much preop and post op time are being billing. That seems to be the crux of this. $100 here and there adds up quickly.

I suppose it does but the wasted surgical time would seem to be a much bigger bang for the buck.
I mean how many times have you slept a patient and waited and waited?

 

[caligas]

Someone please explain this new policy to me like I’m a surgeon

 

[CopaceticOne]

Slow as molasses surgeon: I have a lap chole to do.
Anesthesiologist: Well, you need to pay us $X amount upfront for our services because you are so slow that insurance won't cover all our work.
Surgeon: But that isnt' fair.
Anesthesiologist: Exactly.

 

[DirtDocMD]

The slow surgeons already get punished since they make the same regardless of how long the case takes.

Yeah, maybe, but the problem is are WE going to get punished??

We already get punished, to some extent. I can generate WAY more $$, doing THREE lap choles in 3 hours with a fast surgeon, vs. ONE lap chole that takes all 3 hours, with a slow one.

The insurance company pays more, too, paying the hospital for 3 hours of OR time, when another surgeon would only require 1 hour. The fast surgeon saves them money.

It’s amazing to me that an insurance company would scrutinize an extra $75-$150 of “anesthesia time” (15-30 minutes), but wouldn’t scrutinize $2500/$5000/$10k of OR time.

I guarantee there’d be an uproar from nurses/techs, if their hourly pay went down, every time they got stuck with the “slow surgeon”. I can even remember, in a previous group, where we would routinely discuss dropping slow surgeons (and we occasionally did).

At $24 a unit, for Medicare, and $18-20 for Medicaid, with CRNA’s making $150-$200 an hour and Docs making $300-$400, it’s easy to hemorrhage money on slow surgeons….

 

[caligas]

So if a case goes past whatever their “Physician Work Time” is, then you max out and can’t bill more time?

 

[DirtDocMD]

So if a case goes past whatever their “Physician Work Time” is, then you max out and can’t bill more time?

That’s exactly what I’m wondering. “Will account for work time in the intra-service period..” (not just pre or post op work time), seems to indicate they MIGHT. Even if they only look at induction/wake-up times (in the “intra-service period”), that’s still more scrutiny than a surgeon gets (who is costing the insurance company money by burning OR time, whether he wants to admit it or not), Yes, if WE are slow, it burns time/money, too….

Even my slow anesthesia partners have a hard time wasting more than an extra 5-15 minutes with a slow induction/emergence, vs. some of the surgeons I work with, who can easily waste HOURS per case.

 

[Drwine]

That’s exactly what I’m wondering. “Will account for work time in the intra-service period..” (not just pre or post op work time), seems to indicate they MIGHT. Even if they only look at induction/wake-up times (in the “intra-service period”), that’s still more scrutiny than a surgeon gets (who is costing the insurance company money by burning OR time, whether he wants to admit it or not), Yes, if WE are slow, it burns time/money, too….

Even my slow anesthesia partners have a hard time wasting more than an extra 5-15 minutes with a slow induction/emergence, vs. some of the surgeons I work with, who can easily waste HOURS per case.

The difference of the slowest anesthesiologist in our group is an hour per day to do the same work versus our fastest is an hour a day which is nothing compared to slowest versus fastest surgeons.

 

[DirtDocMD]

The difference of the slowest anesthesiologist in our group is an hour per day to do the same work versus our fastest is an hour a day which is nothing compared to slowest versus fastest surgeons.

Yup.

 

[chessknt]

I mean almost all of medicine is basically on this system already. I get paid the same if it takes me 30 minutes or an hour to see a complicated patient. 2 years ago they started rounding CCM time down for any interval between 30. This is just what is happening now.

 

[abolt18]

The difference of the slowest anesthesiologist in our group is an hour per day to do the same work versus our fastest is an hour a day which is nothing compared to slowest versus fastest surgeons.

One of our trauma surgeons took 6 hours to do a lap chole yesterday... Still within a standard deviation of his norm.

 

[teacher2md]

I guess it will be another thing to add into hospital stipend negotiations: per-hour cost for cases going beyond X hours.

 

[centdoc]

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So if a case goes past whatever their “Physician Work Time” is, then you max out and can’t bill more time?

At worst I hope that’s the jist; from the way I read it, they can outright deny the entire claim. So, now you wasted the day with a slow ass surgeon and not get paid anything.

 

[voxveritatisetlucis]

So why don’t anesthesiologists just say they will no longer accept blue cross blue shield? I’m sure bcbs would have to change their tune?

 

[aneftp]

Just get paid hourly like locums. That solves everyone’s problem except the hospital or whoever is paying the bills.

That’s how you combat this.
Last week i only worked 41 hrs over 4 days.
Next week im over 110 hours

It’s the best way to get paid. Except for the company that’s paying you.

 

[teacher2md]

So why don’t anesthesiologists just say they will no longer accept blue cross blue shield? I’m sure bcbs would have to change their tune?

Because of a little thing called the No Suprises Act…

 

[DirtDocMD]

So why don’t anesthesiologists just say they will no longer accept blue cross blue shield? I’m sure bcbs would have to change their tune?

The issue there is that most contracts that anesthesia groups make with hospitals state they will be “in-network” with any insurance that the hospital is also “in-network” with.

Within a few days of going “out of network”, patients would immediately start complaining to the hospital or their surgeons about “outrageous” anesthesia charges, and pandemonium would ensue (or No Surprises Act would rule, as mentioned by others).

What will have to happen, if this materializes, is that anesthesia groups are going to have to charge even higher subsidies to hospitals, or put language in future contracts that requires the hospital to cover the difference/cost, when some slow surgeon that they continue to schedule/allow block time for, goes “over” the “allowed time”.

If they are getting $50-$100 per MINUTE for OR time, they’ll simply have to get used to coughing up $4-$5 per minute of that, to cover anesthesia’s “shortfall”….

 

[sloh]

So why don’t anesthesiologists just say they will no longer accept blue cross blue shield? I’m sure bcbs would have to change their tune?

A lot of pp anesthesia groups would go out of business if they no longer accepted BCBS. It makes up a huge proportion of their commercially insured patients.

 

[centdoc]

Another fallout from the NSA…. bcBS daring us to go OON

 

[anbuitachi]

our insured patients are mostly medicaid medicare. we often have bills denied and unpaid bc surgeons take so long. not only is it a teaching hospital, the surgeons are just slow. (entire bill gets DENIED. Get 0)

we do 1 robot prostate a day. ive seen them go over 12 hours long. had a ESD colon that is 24 hours long. Lap choles that are 7 hours. etc.

But i am curious what the upper limits are. im also curious if facility fees/OR time gets denied too or is it just professional fees?

 

[CopaceticOne]

our insured patients are mostly medicaid medicare. we often have bills denied and unpaid bc surgeons take so long. not only is it a teaching hospital, the surgeons are just slow. (entire bill gets DENIED. Get 0)

we do 1 robot prostate a day. ive seen them go over 12 hours long. had a ESD colon that is 24 hours long. Lap choles that are 7 hours. etc.

But i am curious what the upper limits are. im also curious if facility fees/OR time gets denied too or is it just professional fees?

Are you employed by the hospital? How are you recouping the lost revenue?

 

[aneftp]

Hourly pay homies. Or just take 20-30 weeks off.

This a crap show these days. Fee for service is dead or close to dead for most anesthesia practices.

The old guard hanging on to the autonomy of controlling your private business. God bless you guys and gals.

 

[GassYous]

Hourly pay homies. Or just take 20-30 weeks off.

This a crap show these days. Fee for service is dead or close to dead for most anesthesia practices.

The old guard hanging on to the autonomy of controlling your private business. God bless you guys and gals.

Yeah I just talked to someone in the locums game now after getting ripped off on a partner track. Taking 26 weeks off working a week at a time and making double what he made. Family is way happier too.

 

[crna2006]

I could be wrong but with the low reimbursement by medicare/Medicaid, and the follow through by private insurance, and the high number of Medicare patients the "subsidy" has become the defacto payment for anesthesia services.
It seems these decisions are largely irrelevant.

 

[UscGhost]

I could be wrong but with the low reimbursement by medicare/Medicaid, and the follow through by private insurance, and the high number of Medicare patients the "subsidy" has become the defacto payment for anesthesia services.
It seems these decisions are largely irrelevant.

That is correct.

Most groups are or will go to a cost plus model.

 

[caligas]

That is correct.

Most groups are or will go to a cost plus model.

So don’t expect many hospitals to endlessly pay out rising 8 figure subsidies vs hiring their own anesthesia staff

 

[UscGhost]

So don’t expect many hospitals to endlessly pay out rising 8 figure subsidies vs hiring their own anesthesia staff

True.

Although not sure if that saves them money or not.

 

[centdoc]

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So don’t expect many hospitals to endlessly pay out rising [emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]]]]] figure subsidies vs hiring their own anesthesia staff

Yes, this is likely the path forward. But there will be a lot of turmoil when the hospital dumps the existing group, and most people just leave. That opens the door for locums!

 

[dannyboy1]

Consequences of NSA. We have no way to to tell the insurance companies to shove it. They can lower the reimbursement as much as they want. Now that we are mostly employed, no one will even make a fuss….

 

[amyl]

What do you mean by cost plus?
I agree - hospitals will pay a premium not to have to deal w anesthesia…. But there’s a tipping point at which they’ll think they can do it better and cheaper… I heard it just happened in Tucson w an envision contract… it’s a familiar story. Sarasota, Tampa, Mednax in Charlotte, Napa in Reno…..

 

[UscGhost]

What do you mean by cost plus?
I agree - hospitals will pay a premium not to have to deal w anesthesia…. But there’s a tipping point at which they’ll think they can do it better and cheaper… I heard it just happened in Tucson w an envision contract… it’s a familiar story. Sarasota, Tampa, Mednax in Charlotte, Napa in Reno…..

The group negotiates a unit rate with the hospital. For example $50 per unit.

The group bills insurance, if it pays less than $50, then the hospital funds the difference.

 

[amyl]

Thanks - I just haven’t heard that terminology before - just heard that called a revenue guarantee

 

[UscGhost]

Thanks - I just haven’t heard that terminology before - just heard that called a revenue guarantee

Yea I think it depends on if there is a management fee or not. Or if the management fee is baked into the unit rate.

So if the docs get 48 and management gets 2 per unit. Then the revenue guarantee would be 50 per unit or the cost plus would be 48 plus 2

Same idea though.

It's a good system overall. Provides some income security to the docs, incentivizes the hospital to use good insurance cases.

Downside is still the issue of booking anesthesia for inefficient rooms

 

[nimbus]

Yea I think it depends on if there is a management fee or not. Or if the management fee is baked into the unit rate.

So if the docs get 48 and management gets 2 per unit. Then the revenue guarantee would be 50 per unit or the cost plus would be 48 plus 2

Same idea though.

It's a good system overall. Provides some income security to the docs, incentivizes the hospital to use good insurance cases.

Downside is still the issue of booking anesthesia for inefficient rooms

They need to guarantee hours of anesthesia time per room too.

 

[anbuitachi]

Are you employed by the hospital? How are you recouping the lost revenue?

im employed and salaried. we did have a revenue part of compensation in addition to salary, but that has gone down every year recently, and now its like negligible. like 10-15k pretax per year total...

 

[anbuitachi]

i support locums. but i thought locums rate are slowly coming down? at least here they are

 

[amyl]

Where’s here? I haven’t seen or heard of the rates going down - a few of my friends doing locums say the same. A few places seem to be upping the permanent offers and that’s probably slowing the locums market locally. It still seems to me that everywhere is short staffed 🤷‍♀️ and everyone needs people.
Recruiters call and text everyday saying this or that place really needs people….