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In order to properly bill for the medical direction of anesthetists by anesthesiologists, HCFA (CMS) and other carrier requirements dictate that certain limits be imposed. One of these limits is that an anesthesiologist can medically direct no more than four anesthetists. If an anesthetist is a resident or student nurse anesthetist, these regulations limit medical direction to two anesthetists. Frequently, a special modifier indicating that medical direction took place is placed on the anesthesia charge and reported to the carrier. Sometimes this modifier indicates to the carrier how many cases were being medically directed.
If more than four anesthetists are performing concurrently under the direction of an anesthesiologist, the anesthetists are considered supervised rather than medically directed and the anesthesiologist is considered to be supervising rather than medically directing. When an anesthesiologist is supervising, the payment for the anesthesiologists services change from base plus time to three (3) total units. In addition, the penalties for fraudulently billing Medicare are quite serious. It is therefore critical to know accurately how many cases were being performed concurrently under the direction of an anesthesiologist.
The Concurrent Case Audit counts concurrent cases by anesthesiologist and date of service. It determines the appropriate modifier for each plan or carrier, it performs and necessary anesthesia charges recalculations, and it performs several data audits. These audits include:
Audit Type
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Audit Description
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Error/Warning
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Physician
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An anesthesiologist is personally performing more than one case simultaneously.
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Error
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An anesthesiologist is personally performing one case and medically directing another case simultaneously.
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Error
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An anesthesiologist is medically directing more than 4 cases simultaneously (supervising).
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Warning
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Assistants
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An anesthetist is personally performing and or is medically directed/supervised on more than one case simultaneously.
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Error
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An anesthesiologist is directing/supervising more than two cases simultaneously and one or more of those cases involves a Student Nurse Anesthetist.
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Error
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Surgeons
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A surgeon is performing two cases simultaneously. This audit is optional and if used is a warning due to the fact the surgery time(s) and anesthesia time(s) for the case are not always equal. A surgeon may have actually started another case with a different anesthesiologist when the patient for the previous case is still under the care of the previous anesthesiologist and the case (for anesthesia purposes) has not "ended".
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Warning
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Facilities
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An anesthesiologist is directing/supervising cases in more than one facility simultaneously.
This audit is optional as the "facility" as defined in MedSuite may not directly correspond to a physically separate building. In some cases it may be a physically separate building, making medical direction an impossibility.
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Warning
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Locations
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An anesthesiologist is directing/supervising cases in more than one location simultaneously.
This audit is optional as the "location" as defined in MedSuite may not directly correspond to a physically separate building. In some cases it may be a physically separate building, making medical direction an impossibility.
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Warning
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O/R Suites
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An anesthesiologist is directing/supervising cases in more than one O/R Suite simultaneously.
This audit is optional as the "OR Suite" as defined in MedSuite may not directly correspond to a physically separate suite or the suite may not be entered causing many cases to be performed in the same (blank) suite.
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Warning
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The Concurrent Case Audit request form contains the following information:
Task Name
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Task Name displayed in the Task Viewer. Defaults to Concurrent Case Audit.
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Generate Report
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The Concurrent Case Audit can be performed with or without generating a report. The concurrent case calculation may be made, charges recalculated, modifiers updated without generating a report.
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Report Only - Do not update Visits
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Checking this option will prevent visits from calculating in concurrency. In addition, the Medical Direction will not be updated on the visits. This will merely print the report, but modifiers and medical direction will NOT be updated on the visits.
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Report Errors Only
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Checking this option will cause the Concurrency Report to print only those cases that have errors or warnings.
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Batch
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Indicates that the Worksheet is to be run against unposted visits for a particular batch
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Batch No
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Batch number to run for unposted visits
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Date
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Indicates that the Worksheet is to be run against all posted and unposted visits for a service date range
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From Date
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Begin date of date range
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Thru Date
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Ending date of date range
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Perform Audit On:
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Indicates that optional audits may be performed on::
These will default to the settings in the Anesthesia tab of the Practice setup unless none are specified there. If no audits are specified in the Practice Setup, they will default here to Physicians and Assistants.
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Cube Data
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Indicates if report results should be output to a data cube
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Generate Standard Report
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Indicates if report results should be output to a formatted report
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Run Now
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Indicates in the report should be run immediately
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Schedule
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Indicates that the report should be scheduled to run at a future time
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Schedule Task Button
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Invokes the Task Schedule Wizard to guide the user through setting the report run date(s) and time(s)
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