Sheridan anesthesia

[aneftp]

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Why? So the new company can allow us to bill in violation of CMS rules? That is a set up for an audit and subsequent fines.

Granted, we DO need a new billing company, but that is another story altogether.

Yeah. It’s hard for the mom and pop small practice to compete with the big amc in terms of billing.

Team health estimated my old mom and pop private practice place left about 750k on the table with our previous billing practice. And that’s BEFORE their increased insurance collections due to them having more power than a mom and pop small practice.

 

[hypnosMD]

Northstar has been called Deathstar on this forum, AFAIK.

I would be VERY careful before signing with any AMC. Work as a locum for them, first.

This times 1000. The last few years i have worked all around the country as a locum for numerous AMC’s including the reviled and dreaded “Deathstar” and can say one thing...any W-2 position with an AMC is the worst of all worlds. Benefits are measly AND your work hours are ill defined AND you have zero security (only worth the cost to replace you with the next new grad vs spread your workload amongst the remaining docs). Since they would never commit to you (true OWNERSHIP and a job that can’t be terminated on a whim), don’t commit to them. Work ONLY as a locum with defined hours at a solid rate, defined overtime/call RATES and a zero cancellation policy. Keep a foot in at several and when (not if!) they pressure you, you can press right back. The people who take the W-2 spot with them are most often less confident docs (for good reason), those with a checkered past, and docs who lack the ability to interpret the fine print in AMC contracts (newbies). Welcome to the jungle!

as an aside, wasn't one of Deathstar's top brass allegedly having an affair with a head CRNA before his fall from grace, including a drunk and disorderly arrest and a picture in the paper?

Deathstar??? More like wandering moral compass (pun intended).

 

[Noyac]

You need a new billing company

CMS is actively looking to make examples of physicians out there cheating the system. And they are winning with the accused getting jail time. Not a good idea to push envelop here.

 

[racerx]

CMS is actively looking to make examples of physicians out there cheating the system. And they are winning with the accused getting jail time. Not a good idea to push envelop here.

Exactly. I'd rather be a free man with a little less jingle in my pocket, thank you.

 

[deleted162650]

Exactly. I'd rather be a free man with a little less jingle in my pocket, thank you.

You can eat well, or you can sleep well . . .

 

[Twiggidy]

You can eat well, or you can sleep well . . .

Since I’m on this Whole 30 thing anyway....I’ll just sleep

 

[DeadSpace]

Since I’m on this Whole 30 thing anyway....I’ll just sleep

Yeah, me too just started. I just bought my yoga pants at Target and a skinny vanilla latte at Starbucks. Let the games begin.

 

[Beach bum]

Exactly. I'd rather be a free man with a little less jingle in my pocket, thank you.

Absolutely hard to understand why anyone would go into this specialty! Truly sad....

 

[deleted162650]

Absolutely hard to understand why anyone would go into this specialty! Truly sad....

Because there are still good, lucrative, fair (and all MD) practices. In fact, this is still rule, not the exception in large portions of the country - just gotta get out of the Northeast/Southeast.

 

[deleted162650]

Yeah, me too just started. I just bought my yoga pants at Target

Please don’t give @Twiggidy any ideas. Pretty sure nobody needs to see that.

 

[Twiggidy]

Please don’t give @Twiggidy any ideas. Pretty sure nobody needs to see that.

 

[chocomorsel]

What’s “whole 30?”

 

[Arch Guillotti]

CMS is actively looking to make examples of physicians out there cheating the system. And they are winning with the accused getting jail time. Not a good idea to push envelop here.

Anesthesiologists?

 

[Arch Guillotti]

Any place having you cover worse than 4:1 is either breaking the law with billing, or screwing themselves.

Why? There are plenty of places that bill for supervision or the qz modifier or whatever.

 

[Noyac]

Anesthesiologists?

Pain docs for sure. I haven’t heard of it happening to anesthesiologists who are strictly in the OR’s. But I wouldn’t put it pat them to go after one if they got the chance.

 

[racerx]

Why? There are plenty of places that bill for supervision or the qz modifier or whatever.

When you bill for supervision, you have the honor of being limited to 3 RVUs per case, regardless of what the case is. If you are doing a 13 RVU spine case, you're leaving a lot on the table and doing the same work in the case.

A group can only use the QZ modifier if they employ the CRNAs themselves. We are happy to let the CRNAs stay hospital employees to avoid the extra expense and drama associated with employing them. Well worth not being able to use the QZ modifier.

 

[Noyac]

Racerx, is there a limit to the number of cases one can bill “supervision” at one time?

 

[vector2]

Is there any concise book or online guide to anesthesia CPTs, RVUs, modifiers, supervision vs direction nuances, etc? How bout the average blended unit based on geographic area?

 

[racerx]

Racerx, is there a limit to the number of cases one can bill “supervision” at one time?

That's a great question. I don't know the answer, but will see if I can find it.

 

[Noyac]

That's a great question. I don't know the answer, but will see if I can find it.

Well, it is my understanding that there isn’t a limit. But it’s been a long time since I have had to “share” a case with a nurse.

 

[GA8314]

This times 1000. The last few years i have worked all around the country as a locum for numerous AMC’s including the reviled and dreaded “Deathstar” and can say one thing...any W-2 position with an AMC is the worst of all worlds. Benefits are measly AND your work hours are ill defined AND you have zero security (only worth the cost to replace you with the next new grad vs spread your workload amongst the remaining docs). Since they would never commit to you (true OWNERSHIP and a job that can’t be terminated on a whim), don’t commit to them. Work ONLY as a locum with defined hours at a solid rate, defined overtime/call RATES and a zero cancellation policy. Keep a foot in at several and when (not if!) they pressure you, you can press right back. The people who take the W-2 spot with them are most often less confident docs (for good reason), those with a checkered past, and docs who lack the ability to interpret the fine print in AMC contracts (newbies). Welcome to the jungle!

as an aside, wasn't one of Deathstar's top brass allegedly having an affair with a head CRNA before his fall from grace, including a drunk and disorderly arrest and a picture in the paper?

Deathstar??? More like wandering moral compass (pun intended).

Anyone know what they do for 401K matching? I'm assuming there is some match but doubt it is much. Just curious.

 

[Scotty_G]

I don't think it's much.

 

[facted]

Anyone know what they do for 401K matching? I'm assuming there is some match but doubt it is much. Just curious.

Are you asking about Northstar in particular or AMCs in general? NAPA funds 20k per year after one calendar year employed, FYI. Vested over time of course.

 

[Noyac]

Are you asking about Northstar in particular or AMCs in general? NAPA funds 20k per year after one calendar year employed, FYI. Vested over time of course.

Vested in how many years?
20k is employment numbers. Not ideal. But it is something.

 

[facted]

Vested in how many years?
20k is employment numbers. Not ideal. But it is something.

20k is partner track, actually. Employees I believe got the same. Vested over 5 years, 20% a year.

It was 30k before they took it down to 20k.

 

[okayplayer]

20k is partner track, actually. Employees I believe got the same. Vested over 5 years, 20% a year.

It was 30k before they took it down to 20k.

Vested over 5 years! Ha!

 

[facted]

Vested over 5 years! Ha!

20% a year. That's their own contribution, anyway. Encouraged people to stay (which is on partner track anyway, so not an issue really). Vesting over a few years is quite common here in the NE, no matter the gig.

How much does your gig give you? Is it vested?

 

[okayplayer]

Nobody gives me a thing. 54k corporate profit sharing plan off the top of my gross (I am a partner in a physician owned group). No vesting period.

I just think a 5 year vesting period for a sh@tty AMC job just sucks. Obviously it’s a feeble attempt to retain their employees. I get it. It just sucks.

 

[Beach bum]

Because there are still good, lucrative, fair (and all MD) practices. In fact, this is still rule, not the exception in large portions of the country - just gotta get out of the Northeast/Southeast.

Does seem like amcs are spreading all over the place though!!

 

[facted]

Nobody gives me a thing. 54k corporate profit sharing plan off the top of my gross (I am a partner in a physician owned group). No vesting period.

I just think a 5 year vesting period for a sh@tty AMC job just sucks. Obviously it’s a feeble attempt to retain their employees. I get it. It just sucks.

Same thing at NAPA. 54K from the top once you're a partner (obviously no vesting). Until then (5 years), they're giving you 20k a year. I fail to see the problem. Everyone is saying how AMC benefits suck, but honestly, fully paid malpractice, reasonable health care costs, 20k 401k contributions, and 6 weeks vacation on the partner track isn't the end of the world. Clearly depends on where in the country you are, but for the NE, it's pretty solid overall.

How much does your group give it's partner track employees per year to their 401k?

 

[Mman]

Why? So the new company can allow us to bill in violation of CMS rules? That is a set up for an audit and subsequent fines.

Granted, we DO need a new billing company, but that is another story altogether.

You aren't violating CMS rules by doing a preop block while supervising rooms. It is one of the 7 "allowable sins" of medical direction. It's equivalent to placing a labor epidural. It's only fraud if you are also trying to bill anesthesia time units for the block.

Your billing company is incorrect and costing you money.

 

[racerx]

You aren't violating CMS rules by doing a preop block while supervising rooms. It is one of the 7 "allowable sins" of medical direction. It's equivalent to placing a labor epidural. It's only fraud if you are also trying to bill anesthesia time units for the block.

Your billing company is incorrect and costing you money.

You're partially correct. It's not a violation if the block is for post-op pain. If the block is used as the primary anesthetic for the patient's upcoming surgical procedure, it is considered the start of anesthesia care for that patient.

 

[Mman]

You're partially correct. It's not a violation if the block is for post-op pain. If the block is used as the primary anesthetic for the patient's upcoming surgical procedure, it is considered the start of anesthesia care for that patient.

I don't think so. It's only the start of anesthesia time if the patient is continually cared for by a member of the anesthesia team. If you have the preop nurse give some versed and you do a block and then leave them in preop holding for a period of time before the anesthetist picks them up to go to the OR you can't start your anesthesia billing time during your block.

If it's a violation, we've violated it 10s of thousands of times and never gotten cited for it.

 

[racerx]

I don't think so. It's only the start of anesthesia time if the patient is continually cared for by a member of the anesthesia team. If you have the preop nurse give some versed and you do a block and then leave them in preop holding for a period of time before the anesthetist picks them up to go to the OR you can't start your anesthesia billing time during your block.

If it's a violation, we've violated it 10s of thousands of times and never gotten cited for it.

I'm just telling you what the compliance officer at our billing company told us. I'd prefer to not test the law. We challenged it, but were told it was as I described it. If you can go without the CMS auditors catching it, good for you. I'm not gonna judge.

As a matter of fact, I think Anesthesiology gets unfairly targeted by the rules, compared to other procedural specialties.

 

[Arch Guillotti]

You're partially correct. It's not a violation if the block is for post-op pain. If the block is used as the primary anesthetic for the patient's upcoming surgical procedure, it is considered the start of anesthesia care for that patient.

Yeah but even if you have the best block in the world everyone gets a crapload of propofol and it turns into a room air general😴😴😴

 

[Mman]

I'm just telling you what the compliance officer at our billing company told us. I'd prefer to not test the law. We challenged it, but were told it was as I described it. If you can go without the CMS auditors catching it, good for you. I'm not gonna judge.

As a matter of fact, I think Anesthesiology gets unfairly targeted by the rules, compared to other procedural specialties.

that's why I'm saying I believe you were told incorrectly by your billing company. CMS specifically allows you to do lines or blocks in preop or PACU while medically directing 4 cases in the OR. Whether the block is for intraop anesthesia or postop pain changes how that gets billed, but doesn't impact the possible concurrency issues.

I'd get a new company to do the billing.