MMP’s depth of expertise greatly benefits our clients, and we would like to share with you some of that industry knowledge in the white papers listed below.

It is important that managed care contracts be closely scrutinized from many angles to assure anesthesia practices are getting the proper reimbursement. Many savvy practice leaders and physicians understand that complex language within a managed care contract requires strict attention to assure reimbursement is met in follow through of what is stipulated. However, many facets of managed care contracts outside of the language can be overlooked and therefore directly affect a practice’s reimbursement. This paper will address both complex contract language and negotiation tactics that can directly and positively impact reimbursement.
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Subsidies or stipends must be beneficial for anesthesia practices and hospitals in order for both to maintain financial stability in an environment marked by shrinking reimbursements, growing competition and rising costs.

Among the major medical specialties, anesthesiology has long represented a relatively small percentage of total healthcare costs and thus generally has not been the target of aggressive payor scrutiny or audits.

But that will likely change as the government's new Medicare audit initiatives gain traction. Chief among these programs is the Recovery Audit Contractors Program (RACs), a nationwide effort that relies on independent contractors to ferret out improper provider payments in exchange for a percentage of the dollars recovered.
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Since 2004, a series of settlements in class action suits brought principally by the American Medical Association and several large state medical societies against the nation's major managed care companies have—to greater or lesser extents—compelled the health plans to discontinue practices that systematically denied physicians’ reimbursement for services rendered to patients.

A primary complaint by the medical societies was the widespread carrier practice of bundling services to avoid paying physicians for specific CPT codes. “Bundling” in this context refers to the use of claim editing software to review certain procedure codes, e.g. a head laceration from a motor vehicle accident, which may be used with a CPT modifier (the -25 modifier) in conjunction with an “evaluation and management” (E/M) service, e.g., CPT 99283 (emergency department visit involving a limited exam and moderate decision making.)
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With reimbursement pressures continuing to grow, ensuring that anesthesia groups collect every dollar they are entitled to has never been more important. Fortunately, this task is made easier if anesthesia groups take steps to reduce or eliminate common documentation and coding mistakes.

Reducing errors requires a detailed, up-to-date understanding of anesthesia coding, a working knowledge of anatomy and open channels of communication between coders and physicians. A process that allows coders to follow-up with physicians on specific case questions and also offers real-time feedback regarding incomplete or inaccurate documentation can go a long way toward strengthening the anesthesia revenue cycle.
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The Physician Quality Reporting Initiative (PQRI), Medicare's two-year-old, quality-reporting program, continues to evolve for 2009 with the inclusion of two additional quality measures for anesthesia providers and an increase in the bonus paid to participating physicians from 1.5 percent to 2 percent.

PQRI was officially launched in 2007 as one of several quality reporting programs developed by the Centers for Medicare & Medicaid Services. The program reflects CMS' goal of gradually shifting the Medicare program toward a greater emphasis on pay-for-performance. Although involvement in PQRI currently is voluntary, most observers expect that participation eventually will become mandatory for Medicare providers.
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By examining current staffing patterns and volume, anesthesia groups should be able to develop staffing models that meet hospital requirements more efficiently. Once these options are identified, groups should next focus on the hospital side of the equation to pinpoint areas where hospital scheduling may be creating undue financial hardship for the group. An OR efficiency study that examines OR utilization by hours-of-the-day frequently will reveal areas ripe for streamlining.
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Hit with improper provider payments that totaled nearly $11 billion in 2007, the Centers for Medicare & Medicaid Services (CMS) is fighting back with an aggressive new program designed to root out fraud, waste and abuse at virtually every level of the Medicare program.

Known as the Medicare Recovery Audit Contractors Program (RAC), the initiative marks a major shift in the way CMS pursues improper provider payments. In the past, Medicare audits have been conducted primarily by fiscal intermediaries or CMS Part B Carriers. With the RACs, however, independent contractors have been enlisted to ferret out improper payments in exchange for a percentage of the dollars recovered.
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Physician groups often find it difficult to carve out time for long-term strategic planning amid the relentless demands and frequent turbulence of day-to-day operations. Yet stepping back to develop solid business objectives has never been more important for medical groups.
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