CARES Act Relief Fund Updates: Application for Additional Financial Relief Payments Now Available as Part of Phase 2.

The CARES Act (Coronavirus Aid, Relief, and Economic Security Act) is a $2.2 trillion economic relief package intended to mitigate the impacts of the coronavirus pandemic. Signed into law in March 2020, this federal program provides direct financial assistance to workers, families, and small businesses, including healthcare and anesthesia providers. Spending areas for this relief package primarily include one-time cash payments to individuals, increased employment benefits, and loan forgiveness and aid to businesses and governments. 

 

Has the pandemic affected your anesthesia practice’s cash flow? Schedule a consultation to find out how you can manage your revenue cycle and adapt your practice to changing conditions.

 

Phase 2 of the CARES Act

On August 10, 2020, the US Department of Health and Human Services (HHS) began accepting applications from certain Medicare, Medicaid, CHIP, and Dental providers who received payments under Phase 1 to determine if they are eligible for the financial relief payments in Phase 2. 

For this round of economic support, the HHS plans to distribute $15 billion to eligible providers. 

 

Who Is Eligible for Payments Under Phase 2?

If your anesthesia practice received a payment under the General Distribution that occurred in April 2020, you may be eligible for the second if you:

  • Missed the June 3 deadline to submit your March and April revenue information; or
  • Have not received General Distribution payments that total 2% of your annual revenue
  • Billed Medicare fee-for-service between Jan.1, 2019 and Dec. 31, 2019; or 
  • Billed Medicaid / CHIP programs or Medicaid managed care plans for health-related services between Jan.1, 2018 and Dec.31, 2019

To learn more about the requirements for the Phase 2 General Distribution, click here

HHS is collecting tax forms and revenue data as part of the application process to calculate a potential payment that is approximately 2% of annual revenue from patient care. If a provider has already received a payment that equals this 2%, they will not receive additional payments. 

Applications and the Taxpayer Identification Number (TIN) verification process must be started by 11:59 pm ET on Friday, August 28, 2020, to be considered for payment.

 

Application Instructions

The application instructions and the sample application form are available at hhs.gov/providerrelief. The website also includes a step-by-step application guide and FAQs. Download and review all of these documents through the Provider Relief Fund Application and Attestation Portal.

If you are still being considered for your Phase 1 General Distribution payment, you must receive either a final payment or communication of ineligibility prior to re-applying in the current Portal for Phase 2.

An Extraordinary Routine: A Day in the Life of an Anesthesia Provider During COVID-19

Throughout the coronavirus pandemic, healthcare professionals have been some of the most affected actors in this real-life drama. In terms of their physical health, as well as the emotional stress and strain they’ve experienced, the toll has been a constant. 

We reached out to anesthesia providers to better understand what the day-to-day looked like for them during these times, and learn more about the efforts they’ve undertaken on behalf of the safety and care of all involved. This story is from the perspective of Lisa, a CRNA. 

 

Starting the Day

My day starts with my mask. I wear my personal mask from the parking deck to the hospital, where I then swap it for my N95 mask and face shield. Afterward, I proceed to the OR desk where I check and record my temperature, and note that, at least thus far, I have not had a fever, headache, or any other symptoms. Since I’ve been symptom-free, I am allowed to proceed to the OR room.

The first thing I do when I get there is “glove up” and wipe down everything in the room. I clean every surface in my workspace, including the anesthesia machine, monitors, keyboards and cables, flat surfaces and drawers/handles, all with OR-approved solution wipes. I will repeat this process after every surgery to make sure the entire area is sanitized for the next patient. 

Next, I set up for my case. I review patient histories and lab work, paying attention to whether or not they have been tested for COVID-19. The majority of our elective surgeries are tested prior to their surgery date. However, emergency cases and in-hospital cases are not likely to have been tested previously. Either way, I wear my gown, gloves, mask, and face shield as if every patient in the OR has COVID-19. This, as part of an involved process, is to make sure I am doing everything I can to protect myself and those around me. 

Masks are required in all areas of the hospital. Everyone is encouraged to wash their hands frequently, and sanitizer dispensers are located throughout the OR, in the hallways, and in patient rooms. 

 

For more on COVID-19 updates for anesthesiologists and CRNA’s, click here

 

Informing and Comforting the Patients

When we resumed elective surgery in May, patients were dropped off at the hospital entrance for their surgery without family or support. It was a very lonely time for them. From my perspective, these patients seemed scared, especially as the protocols in place further isolated them from human touch, removing a certain level of comfort from the experiences they were familiar with. 

When I meet with my patients, I am covered by my gown, gloves, N95 mask, and glasses. I try to convey to them through a muffled voice that I am there to support them and care for them, as if they were my own family. I get less than five minutes to share with each patent that they can trust me and depend on me. I convey to them my confidence in my ability and experience as their anesthesia provider. 

I do my best to alleviate their anxiety by letting them know what they can expect as we move to the operating room. I believe my patients’ frame of mind going to sleep will affect their well-being during surgery and postoperatively. I make every effort to convey that they are in great hands, and the surgical and anesthesia team is fully prepared and there for them. It is essential that the patients trust us in order to relinquish control when the anesthesia begins to take effect. 

After they wake up in the recovery room and are ready to be discharged, their family comes to pick them up, and we give them the instructions for care after leaving the hospital. 

 

 

Changing Protocols 

After about a month of outpatient surgeries only, protocols changed to allow more involved procedures that required overnight stays. Patients were allowed to have one support person with them preoperatively, and both the patient and their company were screened, required to wear masks, and interviewed regarding COVID-19 contact. Patient visitation is limited to one person and ends at 6 p.m. 

I believe that this alleviated some of the anxiety the patients were experiencing. However, my regimen has not changed, and I still meet the patient in full PPE. I continue to try to alleviate their anxiety by conveying to them how well they will be taken care of and that their family will be updated throughout the entire process. 

 

Another change has been the rise of telemedicine in the anesthesiology sector. To learn more about this development, read our most recent blog!

 

Anesthesia Inductions

Anesthesia inductions have always required minimizing aerosolizing particles from patient airways during intubation. In response to COVID-19, a new standard was developed to include full PPE, an N95 mask, an OR mask covering the N95 mask, gloves, gowns, goggles, and face shields. The anesthetic has paralytics that, within 30-45 seconds, provide the muscle relaxation needed to place the endotracheal tube thru the vocal cords, preventing cough and the potential for aerosolizing particles into the air. 

 

Healthcare in the Future

How do I feel about healthcare in the future?

Right now, the industry is ever-changing. We know more today than we did yesterday, last week, last month, and since the start of COVID-19. Continued research and data will give us more insight on how to move forward in making decisions on patient care and protecting essential healthcare workers. 

Based on what I have seen, I believe that most people will end up contracting COVID-19, differing in severity based on exposure, strength, and strain. I think the most important thing that anyone can do is stay informed and take action to protect themselves and the people around them. 

Wear the mask. Is it inconvenient? Sure. Is it infringing on your rights? Not hardly.  Be respectful of others, and be safe. 

Verifying CARES Act Deposits

As you are aware the CARES Act Provider relief funds should have been deposited into your account. The final step is to verify and complete the attestations that your group received the funds. Medical Business Management is here to help if you have any questions or need assistance please let me know.

In order to complete the attestations, you will need the following:

  1. Tax ID Number
  2. Last 6 digits of deposit account number
  3. Relief fund payment amount
  4. Rendering/service address
  5. Billing address

Go to this link and complete the steps.

Step 1 – Eligibility

Select “Yes” to indicate that you received Medicare fee-for-service payments in 2019, read the privacy act, and click continue.

Step 2 – Billing Tax ID number

Enter your TIN and click continue.

Step 3- verify payment information

  • Confirm that your TIN is correct
  • Enter the last six digits of the bank account number
  • Enter the relief fund payment amount
  • Click continue.

Step 4 – Attestations

  • Verify the information is correct and click review and accept
  • Check box for two attestation questions
  • Complete contact information
  • Complete the rendering/service address
  • Complete the billing address (listed above #5)
  • Check the box for “I have read and agree to the Optum pay enrollment agreement terms and conditions”
  • Check the box “I’m not a robot”
  • Click “I accept payment”

Step 5 – Confirmation

Save the confirmation number or a screenshot of the confirmation page.

Conclusion

Medical Business Management is here to help! Call us at (800) 477-4544 if you need assistance.

CMS Adult Elective Surgery and Procedures Recommendations

CMS Adult Elective Surgery and Procedures Recommendations:
Limit all non-essential planned surgeries and procedures, including dental, until further notice

To aggressively address COVID-19, CMS recognizes that the conservation of critical resources such as ventilators and Personal Protective Equipment (PPE) is essential, as well as limiting exposure of patients and staff to the SARS-CoV-2 virus. Following is guidance for limiting non-essential adult elective surgery and medical and surgical procedures, including all dental procedures. These considerations will assist in the management of vital healthcare resources during this public health emergency.

Dental procedures use PPE and have one of the highest risks of transmission due to the close proximity of the healthcare provider to the patient. To reduce the risk of spread and to preserve PPE, we are recommending that all non-essential dental exams and procedures be postponed until further notice.

A tiered framework is provided to inform health systems as they consider resources and how best to provide surgical services and procedures to those whose condition requires emergent or urgent attention to save a life, preserve organ function, and avoid further harms from underlying condition or disease. Decisions remain the responsibility of local healthcare delivery systems, including state and local health officials, and those surgeons who have a direct responsibility to their patients. However, in analyzing the risk and benefit of any planned procedure, not only must the clinical situation be evaluated, but resource conservation must also be considered. These recommendations are meant to be refined over the duration of the crisis based on feedback from subject matter experts. At all times, the supply of personal protective equipment (PPE), hospital and intensive care unit beds, and ventilators should be considered, even in areas that are not currently dealing with COVID-19 infections. Therefore, while case-by-case evaluations are made, we suggest that the following factors to be considered as to whether planned surgery should proceed:

  • Current and projected COVID-19 cases in the facility and region. o consider the following tiered approach in the table below to curtail elective surgeries. The decisions should be made in consultation with the hospital, surgeon, patient, and other public health professionals.
  • Supply of PPE to the facilities in the system
  • Staffing availability
  • Bed availability, especially the intensive care unit (ICU) beds
  • Ventilator availability
  • Health and age of the patient, especially given the risks of concurrent COVID-19 infection during recovery
  • Urgency of the procedure.

Download the CMS Adult Elective Surgery and Procedures Recommendations PDF

Celebrate National CRNA Week With Us

Medical Business Management would like to join with the American Association of Nurse Anesthetists (AANA) in honoring Certified Registered Nurse Anesthetists during National CRNA week. The week of January 20th has been set aside to show appreciation for CRNAs and to raise awareness for the important work that they do.
Nurse anesthetists have been providing anesthesia care to patients in the United States for more than 150 years.

The CRNA Personal Touch

A CRNA doesn’t see their work day as full of procedures to be completed, but full of individuals to be cared for. They are the calming voice that put your fears at ease as they prepare you to undergo your procedure and reassure you that you’re in good hands. These nurse anesthetists are your advocate. They stay with you from start to finish and provide a full spectrum of care while they speak on your behalf to the entire medical team and make sure you stay comfortable throughout your procedure. Known for their personal touch, they are the heart in what can otherwise feel cold and routine. While the doctors and nurses are focused on specific tasks, the CRNA keeps a big picture perspective to ensure your overall well-being. This perspective can play a vital role in coordinating patient care and ensuring the best possible outcome. Join us in saying “Thank you!” to all our CRNAs.

CRNAs are constantly facing new challenges. Medical Business Management values our relationship with CRNAs nationwide, and we are committed to helping our clients navigate these uncertain times. Even if policies change, the expertise that we bring to practice management, coding, reimbursement, and billing will ensure that you are compensated fairly and in a timely manner.

Do you have questions about the work that we do for CRNAs? Contact us today for more information.

Monitored Anesthesia Care vs General Anesthesia

Traditionally, MAC anesthesia cases and general anesthesia cases were very easy to differentiate. General anesthesia refers to patients that are completely asleep and have an endotracheal tube down the throat.  MAC anesthesia (Monitored Anesthesia Care) refers to patients that are not completely asleep (various levels of sedation) and were not intubated.

Propofol and MAC Anesthesia

Propofol has completely changed the nomenclature.

Anesthesia is a continuum, not a designated “label” or “level”. Anxiolysis, light sedation, moderate sedation, deep sedation, general anesthesia.

General anesthesia by definition is when a patient loses their protective airway reflexes.  When they are so sedated that they can no longer swallow saliva, gag reflex has been obtunded, may quit spontaneously breathing, and may obstruct easily.

MAC anesthesia by definition is when the patient receives varying levels of sedation to achieve ideal procedural conditions with patient interaction.

An anesthesia provider can give a little propofol and the patient will be amnestic, yet still have eyes open (awake).  This by definition would be a MAC or light sedation.  However, the anesthesia provider can give a larger dose of propofol and put patient completely asleep so a gastroenterologist can pass a scope into their stomach without the patient gagging or fighting, this by definition would be a general.

From our experience, most if not all endoscopy cases are really general anesthetics by definition.

MAC Anesthesia Reimbursements

According to the ASA relative value guide, the type of insurance should not impact reimbursements, however, many payors now have Monitored Anesthesia Care requirements. Understanding the difference between MAC and General allows the billing company to apply the correct anesthesia modifier and for the claims to be paid quickly and correctly.

What is MAC Anesthesia?

MAC stands for Monitored Anesthesia Care. MAC is not necessarily a type of anesthesia but more of a
style of anesthesia.

Monitored Anesthesia Care (MAC) includes all aspects of anesthesia care, a pre-procedure visit, intra-procedure care and post-procedure anesthesia management. While MAC may include the administration of sedatives and analgesics often used for Moderate Sedation, the MAC provider must be prepared and qualified to convert to general anesthesia when necessary.

Sedation With MAC Anesthesia

MAC allows for the safe administration of maximal depth of sedation. MAC provides the ability to adjust sedation levels from full consciousness to general anesthesia during the course of a procedure; this flexibility provides matching sedation levels for the patient and proceduralist requirements to achieve ideal procedural conditions.

During a MAC procedure, if the patient loses consciousness and the ability to respond purposefully, the anesthesia care by definition is converted to a general anesthetic regardless of whether airway instrumentation is required.

MAC Anesthesia Post-Procedure Care

MAC anesthesia requires post-procedure care such as return to full consciousness, relief of pain, psychological support and physical comfort as well as the diagnosis and treatment of co-existing medical problems.

Monitored Anesthesia Care is a physician service that must be provided by a qualified anesthesia provider, it should be subject to the same level of payment as general anesthesia.

Anesthesia Salaries Are Increasing – But for How Long?

anesthesia salaries

Even in an overall flat-pay situation for medical professionals, anesthesia salaries are on the rise—but there’s a threat to that trend in the form of a decrease in the number of surgeons. This could cause a future drop in the demand for anesthesiologists, leaving some anesthesia providers out of work.

The Current State of Anesthesia Salaries

The Bureau of Labor Statistics states that physician pay is stable, but from 2004 to 2014, salaries for anesthesiologists has increased. A study led by David DeKorte, JD, from Pennsylvania State University, collected data from the Bureau of Labor Statistics, the U.S. Department of Education, and the Association of American Medical Colleges to determine the effect of educational interest and salaries on the future of anesthesiology. His findings were presented at the 2017 PostGraduate Assembly in Anesthesiology.

From 2004 to 2014, the increase in anesthesia salaries was a rate of 1.21% per yearhigher than any other sector in the medical field. The salaries for anesthesiologists in 2014 was higher than other specialties, boasting a median of $246,650a significant $6,000 more than surgeons, who came in as the second highest-paid group. The field of anesthesiology grew almost 20% during this time period, as well, while the other fields only saw growth of 3%.

Factors in the Decline in Surgeons

Unfortunately, while anesthesiologists were experiencing a raise in pay, surgeons were seeing a decline of professionals in their field. In the same time period (2004-2014), the number of surgeons fell 26.4%over 4% per year. According to Mr. DeKorte, the reasons for this decline were myriad, from the demands of residency to the burden of student debt. Additionally, surgeon salaries have increased only 0.55% per year, which may also contribute to the decreased numbers of people entering that occupation.

Educational expenses play into this equation as well, with undergraduate and medical training costs having risen 23% and 27.9% respectively. It’s true that admissions to medical school have gone up, but the significant growth in student debt may cause students to avoid specialties that require long, costly residencies.

The Overall Effect

The decline in surgeons could result in a lower demand for anesthesiologists, which could have a long-term effect on both anesthesia salaries and the number of anesthesiology positions available. And that’s assuming students continue to believe that the cost of medical school and all its trappings is worth it—which, given that they’ll be paying about half of their income to student loan debt upon finishing, isn’t necessarily a given.

MBM Relieves Physician Burdens

Here at Medical Business Management, we believe that physicians should be able to focus on their practice and their patients. To help them accomplish that, we are available to take on their billing and coding, collecting payments and following up with unpaid bills as necessary.

If you’d like to find out more about what we can do for your practice, contact us today.

4 Great Apps for Anesthesiologists

apps for anesthesiologists

You may not think about anesthesiologists needing or using smartphone apps for their practice, but there are several out there that are worth checking out. Always do your homework, of course, and make sure that these apps fit your needs and work accurately before using them; we make no claims that these apps are flawless or are a good fit for your practice.

That said, they could be helpful to you or your staff. Read on!

Graphium MACRA

With MACRA’s implementation in 2017, anything that makes the process easier is worth its weight in gold. This app allows you to capture necessary measures and report your MACRA requirements. By tracking far more than just quality, you’ll have an unprecedented view into operational excellence. Learn more at macraready.com.

AnestAssist PK/PD

Apple Store description: “AnestAssist PK/PD is an educational tool used for understanding and visualizing the pharmacokinetics, pharmacodynamics, and interactions of commonly used anesthetic drugs.”

This app could be a great tool for anesthesiologists, CRNAs, veterinarians, and anyone else involved with anesthesia. Whether you’re a resident or you’ve got 25 years of experience under your belt, you can benefit from this app’s real-time case capture, modeled interactions, and more.

Released in 2009 and updated in November 2014, this app is available in the app store for $19.99 and can be used on an iPhone, iPod Touch, or iPad.

Anesthesia

Apple Store description: “The Anesthesia application provides access to Mobile Medical Media’s suite of 11 ultrasound guided regional anesthesia video tutorials on your iPhone or iPod Touch.”

Whether you need a quick refresher or you’re looking for a deeper understanding of a concept, this app has the tutorials you’re looking for. Great for students, too. It’s available in the app store for $59.99 and can be used on the iPhone, iPod Touch, and iPad.

Anesthesia Central

Apple Store description: “Anesthesia Central is a must-have resource for every anesthesiologist, critical care specialist, nurse anesthetist, and trainee. Consult the automatically updating collection of disease, drug, test, and procedure information for treating patients before, during, and after surgery. Download to your mobile device and use the quick-read format to find answers fast or search for journal articles and citations in the full PubMed database – anytime, anywhere.”

With five comprehensive resources included, Anesthesia Central offers a free preview so you can try before you buy. Find it in the app store for free, then purchase for $99.99 after one year to continue receiving updates.  

At MBM, Apps for Anesthesiologists Are Just the Beginning

Our goal is to help anesthesiologists focus on their patients – not on paperwork, coding, or claims. The above apps could help to streamline your practice, and so could letting us handle all your billing and coding. Contact us today for more information on how we can remove these burdens and help your practice thrive!

5 Ways to Get Involved for Patient Safety Awareness Week

patient safety awareness week

Every year, the United in Patient Safety campaign comes to a close with Patient Safety Awareness Week. This year, March 12-18 is the observed week for dedicating time and energy to increasing awareness for patient safety. In order to further this cause, the National Patient Safety Foundation brings health professionals and patients together to spread the message about the importance of patient safety.

Read on for ways to get involved!

#1: Wear a Patient Gown to Work

One of the most visually obvious ways that health care professionals are encouraged to observe this week is by wearing a hospital gown on the job. President and CEO of NPSF, Tejal K. Ghandi, MD, MPH, CPPS, says, “We are all patients, after all. We want leaders to demonstrate a commitment to listen to the patient’s voice and strive for patient safety and the reduction of harm.”

#2: Use Social Media to its Fullest Potential

If your practice has a Facebook page, a Twitter account, an Instagram account, or a Snapchat account, be sure to post pictures of your staff in their patient gowns and explain that you are observing Patient Safety Awareness Week! Not sure what to say in your post? Try these helpful pre-written samples.

#3: Take Advantage of Campaign Materials

There are lots of materials for the campaign available for download online. You can also order items specifically for Patient Safety Awareness Week.

#4: Register on the Campaign Website

To make sure your practice stays in the loop for all campaign activities, take a moment to register here.

#5: Discuss Issues with Other Professionals

One interactive way to engage the purpose of this week is by discussing patient safety issues with other health care professionals. Through this discussion forum, you can take part in conversation surrounding health care issues, share your own experiences, and learn from the expertise of others. Join the discussion here.

Make Patient Safety Awareness Week a Success!

At Medical Business Management, we’re passionate about the wellbeing of patients and health care professionals alike. That’s why we offer services meant to relieve stress and encourage more efficient productivity. Ready to talk to us about how we can help your practice reach its full potential? Contact us today!

CARES Act Relief Fund Updates: Application for Additional Financial Relief Payments Now Available as Part of Phase 2.

The CARES Act (Coronavirus Aid, Relief, and Economic Security Act) is a $2.2 trillion economic relief package intended to mitigate the impacts of the coronavirus pandemic. Signed into law in March 2020, this federal program provides direct financial assistance to workers, families, and small businesses, including healthcare and anesthesia providers. Spending areas for this relief […]

An Extraordinary Routine: A Day in the Life of an Anesthesia Provider During COVID-19

Throughout the coronavirus pandemic, healthcare professionals have been some of the most affected actors in this real-life drama. In terms of their physical health, as well as the emotional stress and strain they’ve experienced, the toll has been a constant.  We reached out to anesthesia providers to better understand what the day-to-day looked like for […]

Verifying CARES Act Deposits

As you are aware the CARES Act Provider relief funds should have been deposited into your account. The final step is to verify and complete the attestations that your group received the funds. Medical Business Management is here to help if you have any questions or need assistance please let me know. In order to […]

CMS Adult Elective Surgery and Procedures Recommendations

CMS Adult Elective Surgery and Procedures Recommendations: Limit all non-essential planned surgeries and procedures, including dental, until further notice To aggressively address COVID-19, CMS recognizes that the conservation of critical resources such as ventilators and Personal Protective Equipment (PPE) is essential, as well as limiting exposure of patients and staff to the SARS-CoV-2 virus. Following […]

Celebrate National CRNA Week With Us

Medical Business Management would like to join with the American Association of Nurse Anesthetists (AANA) in honoring Certified Registered Nurse Anesthetists during National CRNA week. The week of January 20th has been set aside to show appreciation for CRNAs and to raise awareness for the important work that they do. Nurse anesthetists have been providing […]

Monitored Anesthesia Care vs General Anesthesia

Traditionally, MAC anesthesia cases and general anesthesia cases were very easy to differentiate. General anesthesia refers to patients that are completely asleep and have an endotracheal tube down the throat.  MAC anesthesia (Monitored Anesthesia Care) refers to patients that are not completely asleep (various levels of sedation) and were not intubated. Propofol and MAC Anesthesia […]

What is MAC Anesthesia?

MAC stands for Monitored Anesthesia Care. MAC is not necessarily a type of anesthesia but more of a style of anesthesia. Monitored Anesthesia Care (MAC) includes all aspects of anesthesia care, a pre-procedure visit, intra-procedure care and post-procedure anesthesia management. While MAC may include the administration of sedatives and analgesics often used for Moderate Sedation, […]

4 Great Apps for Anesthesiologists

You may not think about anesthesiologists needing or using smartphone apps for their practice, but there are several out there that are worth checking out. Always do your homework, of course, and make sure that these apps fit your needs and work accurately before using them; we make no claims that these apps are flawless […]