More billing for ACT model?

[coffeebythelake]

A GI doc insists that ACT model is more expensive than solo CRNA because parient gets two bills from anesthesia. Pretty damned sure he is wrong. As I understand it the billing modifier (QX, QZ) is different and the total anesthesia bill to patient should be the same even if there is separate billing from anesthesiologist and CRNA. I dont do my own billing. Can someone in PP (or do their own billing) give me the lowdown on this?

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[GassYous]

Just once. Imagine if we could double bill? I would peek into the spine rooms every case

 

[Endee]

Anesthesia bill is $100. Solo physician sends bill for $100. Solo CRNA sends bill for $100. ACT sends bill for $50 for physician and $50 for non-physician. Patient cost is the same regardless of who performs the anesthetic. This is one of AANA's biggest lies, that CRNA's are "cheaper."

 

[chocomorsel]

What about in the situation where the CRNAs work for the hospital and docs are independent? Anyone know how that billing works?

 

[Endee]

What about in the situation where the CRNAs work for the hospital and docs are independent? Anyone know how that billing works?

I'm guessing 50% would go to the hospital as the CRNA's employer and 50% to the physician's group. There is probably still only one extra bill, because the CRNA portion is probably included in the hospital's bill. No changes to overall anesthesia charges.

 

[abolt18]

A GI doc insists that ACT model is more expensive than solo CRNA because parient gets two bills from anesthesia. Pretty damned sure he is wrong. As I understand it the billing modifier (QX, QZ) is different and the total anesthesia bill to patient should be the same even if there is separate billing from anesthesiologist and CRNA. I dont do my own billing. Can someone in PP (or do their own billing) give me the lowdown on this?

Patient should get ONE bill for the anesthesia provided. The money billed goes to whoever is doing the billing (hospital, anesthesia group, whatever), and money is distributed as contracted (salary, hourly, per unit, per FTE, etc.).

QZ modifier just bills as if there were no physician involved. The physician doesn't follow suit by billing AGAIN on top of the QZ modifier. This is what our hospital does for any case involving crnas. Hospital requireyd physician to supervise every single case, but the state legislature does not (for billing). The patient gets only 1 bill for the anesthesia services provided, but if there was a crna then they bill it with QZ.

 

[coffeebythelake]

Patient should get ONE bill for the anesthesia provided. The money billed goes to whoever is doing the billing (hospital, anesthesia group, whatever), and money is distributed as contracted (salary, hourly, per unit, per FTE, etc.).

QZ modifier just bills as if there were no physician involved. The physician doesn't follow suit by billing AGAIN on top of the QZ modifier. This is what our hospital does for any case involving crnas. Hospital requireyd physician to supervise every single case, but the state legislature does not (for billing). The patient gets only 1 bill for the anesthesia services provided, but if there was a crna then they bill it with QZ.

So what you are saying is for ACT model in your house it is billed once as QZ (100% fee schedule). Technically not the correct use of that modifier. Shouldn't it be QX for CRNA and QK for MD w 2 to 4 concurrent cases (each 50% fee schedule) and billed by both CRNA and MD (x2 = same total fee for aneathesia services)?

 

[abolt18]

So what you are saying is for ACT model in your house it is billed once as QZ (100% fee schedule). Technically not the correct use of that modifier. Shouldn't it be QX and QK (each 50% fee schedule) and billed by both CRNA and MD (x2 = same total fee for aneathesia services)?

Officially, if the attending were ONLY medically directing 1 room, it would be a QY modifier. As soon as they're medically directing > 1 and
In either case, patients only get one bill for the anesthetic. The rate is reduced as the number of rooms supervised increases, but the group bills for one single amount for the anesthesia. There is not a separate bill or reimbursement for the crna/AA. One price. One bill. One reimbursement. Then it's up to the group and its prearranged payment methods to determine where that money goes after payment. (A certain amount may have to go to the hospital if they are the ones employing the crnas for example)

 

[abolt18]

And I fully acknowledge that I may be off base here. I am a resident with very limited actual exposure to billing procedures. This is just my understanding of how it all works.

 

[B-Bone]

Officially, if the attending were ONLY medically directing 1 room, it would be a QY modifier. As soon as they're medically directing > 1 and
In either case, patients only get one bill for the anesthetic. The rate is reduced as the number of rooms supervised increases, but the group bills for one single amount for the anesthesia. There is not a separate bill or reimbursement for the crna/AA. One price. One bill. One reimbursement. Then it's up to the group and its prearranged payment methods to determine where that money goes after payment. (A certain amount may have to go to the hospital if they are the ones employing the crnas for example)

This may or may not be true, depending on how the anesthesia care team is employed/structured. I am in a PP group that employs the CRNAs we work with at most of our sites, but work with hospital-employed CRNAs at another site. We have our own billing company. At most of our sites, patients receive one bill for anesthesia which includes both the MD and CRNA fees. At the site where we don't employ (and also don't bill for) the CRNAs, the patients receive two bills for anesthesia: one for the MD fee from our billing company and one for the CRNA's fee from the hospital. Each are for 50% of the total anesthesia fee, although interestingly, I don't think they are necessarily equal because of diffferent billing companies negotiated rates with different payors. Thus, the MD 50% could be more (or less) than the CRNA 50% because while each biller submits a bill for 50% of the units, they may be paid a different rate for those units. I've never actually seen what the hospital is billing. That would be interesting.

 

[abolt18]

This may or may not be true, depending on how the anesthesia care team is employed/structured. I am in a PP group that employs the CRNAs we work with at most of our sites, but work with hospital-employed CRNAs at another site. We have our own billing company. At most of our sites, patients receive one bill for anesthesia which includes both the MD and CRNA fees. At the site where we don't employ (and also don't bill for) the CRNAs, the patients receive two bills for anesthesia: one for the MD fee from our billing company and one for the CRNA's fee from the hospital. Each are for 50% of the total anesthesia fee, although interestingly, I don't think they are necessarily equal because of diffferent billing companies negotiated rates with different payors. Thus, the MD 50% could be more (or less) than the CRNA 50% because while each biller submits a bill for 50% of the units, they may be paid a different rate for those units. I've never actually seen what the hospital is billing. That would be interesting.

This is pretty surprising to me.

 

[OneFellSwoop]

I agree with B Bone as I’m in a similar situation. We are a private group but the CRNAs are employed by the hospital. Because the Insurance company has a different negotiated rates with crna or anesthesiologist the billed medical direction rate is different for CRNA and anesthesiologist, thus, patients get 2 bills. I can confirm this because I’ve been a surgical patient in our system.

CMS truly is 50:50.