Medicare rates

[deleted162650]

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i was told medicare/medicaid doesnt pay for blocks for postop pain in ny?

MediCare is a national program, so there shouldn’t be state to state variance on something like that. MediCaid varies by state, but I have no idea what they do in NY. A quick call to your billers should provide the answers you seek.

 

[ZzzPlz]

Brachial plexus blocks are 8 units. Use U/S and you can bill 2 more for a grand total of (get this) 10 units!!

I had no idea they were worth that many units! I need to talk to our billing guy.

how many units for TAP?

thanks.

 

[deleted162650]

I had no idea they were worth that many units! I need to talk to our billing guy.

how many units for TAP?

thanks.

Do they not have Google where you live??

TAPs are 5. You should download the free Abeo coder app so you can track the units for all your cases.

 

[TheLoneWolf]

Do they not have Google where you live??

TAPs are 5. You should download the free Abeo coder app so you can track the units for all your cases.

Do you need a login or account?

 

[deleted162650]

Do you need a login or account?

Nope

 

[dhb]

Brachial plexus blocks are 8 units. Use U/S and you can bill 2 more for a grand total of (get this) 10 units!!

I'll have 20 carpal tunnels for 10k please.

 

[deleted162650]

I'll have 20 carpal tunnels for 10k please.

Who does blocks for carpal tunnels?

 

[dhb]

Who does blocks for carpal tunnels?

Europeans

 

[deleted162650]

Europeans

If the block is your primary anesthetic, you cannot bill separately for it. If you’re doing blocks for post-op pain after CTRs then that confirms my suspicions that Europeans are a bunch of p**sies.

 

[dhb]

If the block is your primary anesthetic, you cannot bill separately for it. If you’re doing blocks for post-op pain after CTRs then that confirms my suspicions that Europeans are a bunch of p**sies.

Yes primary anesthetic.
So you can have a post op block pay more than the procedure itself?

 

[d9sccr]

Agree if you’re talking about value to the patient. I was talking more about the effort and energy required on my part....it’s not much.

No real disagreement. I think we often forgot how much training and to a degree ability it takes to do what we do day in and day out. Just because it’s an easy thing for you, there are still real complications to putting a needle near the brachial plexus.

Yes primary anesthetic.
So you can have a post op block pay more than the procedure itself?

Yeah..as far as I know, most insurance companies don't payout the full US unit value, but the rest is fair game. Primary anesthetic still has to be a GA to bill for post-op pain though

 

[anes121508]

I’m young and don’t know billing well. Reading this thread and surprise billing stuff in the news trying to understand why it’s so bad for us. At first glance, I say to myself “well that seems fair, I shouldn’t bill some outrageous amount for a nerve block just because the patients surgeon was in network but I’m not in network”.

Is this correct?....

I think someone mentioned this but since the solution is to cap surprise billing at 120% of Medicare rates AND the in network rates are 300% of Medicare....then why would any private company even negotiate a rate for in network? Just let everyone be out of network and get charged the 120% which is less than what they are being charged now. The indirect result of the cap on the surprise billing is that it is below current in network rates with private insurance companies and will drag all reimbursement rates down?

I’d assume the solution is to make the cap specialty specific so doesn’t effect the current negotiated in network rates?

 

[anes121508]

Isn’t it obvious to the people making this law that the insurance companies are simply taking advantage of the situation and trying to get a 120% cap? Why wouldn’t the cap on surprise billing be similar to whatever innetwork rates they currently have?

 

[PieOHmy]

Can't default from student loans unless you have a fake death certificate.

What are you talking about?
Our salaries are

I have always said that the day my salary plummets to that of a family med doc will be the day I default on my loans and leave this country. I am sure I am not alone here in this view.

what are you talking about?

anesthesia docs make 175/hr. generally.
Hospitalist can make that..
So who is doing better?

 

[PieOHmy]

A lot of “sky is falling” in this thread. IF Medicare for all ever becomes a reality and IF insurance companies just shrug and say “well we had a good run” and IF Medicare rates stay the same for anesthesia then the hospitals will have to find a way to supplement anesthesia income. Even cheap, solo CRNAs won’t be dumb enough to take call on nights, weekends, and holidays for $100k a year. If the hospitals want the ORs to run, they will have to pay for it...someone will have to pay for it. There’s a lot of “IFs” there, though.

Otherwise pay off debts and stop buying boats.

Theve been subsidizing anesthesia for years and years. That is what brought the invention of the anesthesia management companies. That worked for a while, when mgt companies saved money with a lot of scale. Now they want to squeeze even more. So it is inevitable that anesthesiology IS heading towards FULL EMPLOYMENT by hospitals. Thats not such a bad thing especially when most everyone working today has no shot at becoming a partner. Thus, the only way to win is to negotiate a hourly wage that youre comfortable with so if they work you to the bone 60-80 hours per week with a majority of that after hours (before 7 am,after 3 pm) at least youll get richer the more time you spend in the hospital. So you are winning in some sorto f way.
Once that happens the hospitals may throw in the towel and buy the insurance companies to try to control the rates. and it goes round and round until EVERYONE is getting ****ed and the janitor is the one providing the anesthesia.

Make no bone about it. NOBODY cares about Quality. NOBODY!!
They only say they do to be able to pay people less for less than perfect results and we know that is not achievable.

 

[PainDrain]

what are you talking about?

anesthesia docs make 175/hr. generally.
Hospitalist can make that..
So who is doing better?

Huh? I don’t even know how to respond to this.

 

[deleted162650]

Huh? I don’t even know how to respond to this.

He’s a member of the My Job Sucks So Everyone Else’s Must Suck Too club.

 

[Zekchar]

Theve been subsidizing anesthesia for years and years. That is what brought the invention of the anesthesia management companies. That worked for a while, when mgt companies saved money with a lot of scale. Now they want to squeeze even more. So it is inevitable that anesthesiology IS heading towards FULL EMPLOYMENT by hospitals. Thats not such a bad thing especially when most everyone working today has no shot at becoming a partner. Thus, the only way to win is to negotiate a hourly wage that youre comfortable with so if they work you to the bone 60-80 hours per week with a majority of that after hours (before 7 am,after 3 pm) at least youll get richer the more time you spend in the hospital. So you are winning in some sorto f way.
Once that happens the hospitals may throw in the towel and buy the insurance companies to try to control the rates. and it goes round and round until EVERYONE is getting ****ed and the janitor is the one providing the anesthesia.

Make no bone about it. NOBODY cares about Quality. NOBODY!!
They only say they do to be able to pay people less for less than perfect results and we know that is not achievable.

I completely agree
1) "most everyone working today has no shot at becoming a partner" - Absolutely true. The private groups string along new and inexperienced grads with this pie in the sky dream then either sell to AMC or find a reason not to grant partner, or allow them to make partner, but not "full partner" so with diminished revenue sharing. Simply ask yourself ... unless you are in a completely remote and undesirable location, why would you as a full partner take in new "partners" and further dilute your revenue share bonus unless you can't get anyone to come work at your location. In short ... you don't, and instead sell the youth on lies, hopes, and dreams.
2) "Thus, the only way to win is to negotiate a hourly wage that you're comfortable with so if they work you to the bone 60-80 hours per week" - Absolutely true. This isn't quite "winning" so much as "living and working" but the point stands. Figure out how much you are willing to work and see what others working that amount are making in a given geographical area. If you don't like the result, time to move geographic areas. Despite everyone insisting otherwise, we are all quite mobile if the situation makes sense. Don't limit yourself .... or if you do accept the financial consequences of your own self limitation.

 

[anbuitachi]

I’m young and don’t know billing well. Reading this thread and surprise billing stuff in the news trying to understand why it’s so bad for us. At first glance, I say to myself “well that seems fair, I shouldn’t bill some outrageous amount for a nerve block just because the patients surgeon was in network but I’m not in network”.

Is this correct?....

I think someone mentioned this but since the solution is to cap surprise billing at 120% of Medicare rates AND the in network rates are 300% of Medicare....then why would any private company even negotiate a rate for in network? Just let everyone be out of network and get charged the 120% which is less than what they are being charged now. The indirect result of the cap on the surprise billing is that it is below current in network rates with private insurance companies and will drag all reimbursement rates down?

I’d assume the solution is to make the cap specialty specific so doesn’t effect the current negotiated in network rates?

Yea the negotiation part is correct. Getting rid of surprise billing is ok with me, its the rates they proposed at that is garbage and is just trying to screw doctors over, as usual.

 

[anes121508]

Yea the negotiation part is correct. Getting rid of surprise billing is ok with me, its the rates they proposed at that is garbage and is just trying to screw doctors over, as usual.

I read a few articles and did a little google search...seems like many are writing about a third party to settle the dispute when patient is out of network. What do you all think about that plan?

 

[hununuh]

Agree if you’re talking about value to the patient. I was talking more about the effort and energy required on my part....it’s not much.

Its not that much effort on your part after 4 years of undergrad, 4 years of medical school, 4 years of residency, and possibly fellowship, all while taking the liability for a procedure that could get you sued (extremely unlikely, but you get the point)

Do you think all these professional musicians that charge $500/hr for lessons or lawyer that charges $1000/hr charge that much bc it takes them a lot of effort to provide their service?

 

[hununuh]

Do they not have Google where you live??

TAPs are 5. You should download the free Abeo coder app so you can track the units for all your cases.

Is it 5 units per side? So 10 for TAPs on both side of the abdomen? Or just 5 total?

 

[deleted162650]

Is it 5 units per side? So 10 for TAPs on both side of the abdomen? Or just 5 total?

5 per side, but you can only bill for ultrasound once. Now whether or not the insurance company will pay you all that is another story.

 

[StillAwake]

5 per side, but you can only bill for ultrasound once. Now whether or not the insurance company will pay you all that is another story.

In my experience, the insurance companies do not pay 5 units for peripheral nerve blocks. Closer to the equivalent of 2 or 3 units.

 

[deleted162650]

In my experience, the insurance companies do not pay 5 units for peripheral nerve blocks. Closer to the equivalent of 2 or 3 units.

Depends on your specific contract with them. Often times they will pay for procedures (both lines and blocks) via a different rate schedule that is the same as if, say, a surgeon was inserting a line instead of using the ASA units scheme. This is all negotiable and contract specific.

 

[facted]

Who does blocks for carpal tunnels?

We did in residency. Maximum resident benefit I guess. Now our surgeons do them awake. Go figure.

 

[deleted87051]

We did in residency. Maximum resident benefit I guess. Now our surgeons do them awake. Go figure.

When I was a resident, the academic hand guru took over 2 hrs for each one. 3 carpal tunnels was a full day. He couldn’t do them awake. In my 2nd job out of residency, I worked with a guy who did them in 8-10min all with sedation. We’d do 10 in a morning. It’s like they were 2 completely different procedures.

 

[StillAwake]

Depends on your specific contract with them. Often times they will pay for procedures (both lines and blocks) via a different rate schedule that is the same as if, say, a surgeon was inserting a line instead of using the ASA units scheme. This is all negotiable and contract specific.

Correct. I was just saying our reimbursement for a block is not equivalent to 5 units. The reimbursement is based on a contracted rate that in general is closer to 2 or 3 units, not that they reimburse for 2 or 3 units. Sorry for the confusion.

 

[deleted87051]

Isn’t it obvious to the people making this law that the insurance companies are simply taking advantage of the situation and trying to get a 120% cap? Why wouldn’t the cap on surprise billing be similar to whatever innetwork rates they currently have?

120% of Medicare is decent reimbursement for most other specialties. This problem strikes anesthesia harder than other specialists.

 

[DrZzZz]

When I was a resident, the academic hand guru took over 2 hrs for each one. 3 carpal tunnels was a full day. He couldn’t do them awake. In my 2nd job out of residency, I worked with a guy who did them in 8-10min all with sedation. We’d do 10 in a morning. It’s like they were 2 completely different procedures.

I had both in residency. One guy at the main campus took 2ish hours and he did his own local. At the ortho center we rotated at, there was a guy that wanted Ax blocks (we really only blocked the median though, not a full ax block) with lidocaine and would put his own marcaine in the incision. Our block was surgical anesthesia, his was for postop pain. Usually 10 minutes OP time, so he'd often get 3 OR rooms for flip purposes. We'd do like 15 carpals by early afternoon. Great experience for efficiency.

Out in practice, still varies by surgeon. Some we do Mac with local infiltration, others want Bier blocks. We don't do Ax blocks for anyone though.

 

[deleted87051]

I had both in residency. One guy at the main campus took 2ish hours and he did his own local. At the ortho center we rotated at, there was a guy that wanted Ax blocks (we really only blocked the median though, not a full ax block) with lidocaine and would put his own marcaine in the incision. Our block was surgical anesthesia, his was for postop pain. Usually 10 minutes OP time, so he'd often get 3 OR rooms for flip purposes. We'd do like 15 carpals by early afternoon. Great experience for efficiency.

Out in practice, still varies by surgeon. Some we do Mac with local infiltration, others want Bier blocks. We don't do Ax blocks for anyone though.

Ax blocks!? You must be an old timer like me.

 

[DrZzZz]

Ax blocks!? You must be an old timer like me.

Only graduated within the last few years, but trained at a program where everyone loved Ax blocks. I don't do them often in practice. Supraclav is quicker in the fast paced PP world I'm in.

 

[deleted941485]

Popping over from EM

Same **** happening over here

M4A probably not a political reality anytime soon, but the immediate danger, which was already mentioned, is the balance billing legislation which seeks to set out of network reimbursement to average in network reimbursement. Which, if you see what the insurance industry is trying to do by lowering in network reimbursement, you can see how this will go.

Everyone should be contacting their representatives in Congress about this.

With regards to "supervision," I quit a place where we were being forced to see 2 patients per house on our own and then supervise another 2 pph with the midlevels. We have been sheeped by the corporations. Run.



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But but Liz Warren has a plan! A 3 year smooth transition to govt medical care.