Americans are insisting on consistency, reliability and accountability from their healthcare system and providers. This demand has triggered a broad-based commitment to seeking a much improved approach to managing quality and cost, one in which specialists collaborate regarding a patient’s care and evidence exists that technology serves to make the system more efficient and effective rather than just more expensive.
Therefore, new regulations are being introduced that provide incentives that assure that the system works better as a whole rather than as the sum of its parts. Fee-for-service medicine is transitioning to healthcare informatics. In the past, anesthesia practitioners could rely on competent in-house billers and coders to sustain financial order. However, with the new regulations and data driven technology, the new age of healthcare practice management is here with drastic changes. As technology has evolved over the past ten years, so has the technology of record-keeping, billing and practice management. Practice data analytics are now being used and referred to as healthcare informatics giving practitioners precise practice measurements in all areas of the anesthesia practice.
Anesthesiology Practice Informatics
Practice Informatics are defined as “an evolving specialization that links information technology, communications and healthcare to improve the quality and safety of patient care.”
Jim Malloy, CEO of Global Health Management Services, states,
“Think of it as Healthcare meets IT. Now common in-house tasks such as medical record-keeping, patient diagnosis and outcome, billing, coding, managed care contracts, claims appeals and collections can be tracked, recorded and analyzed for precise practice revenue measurements.”
Today, to stay current with the rapid growth of healthcare informatics relating to data capture and reporting, it is mandatory for anesthesia providers to engage professionals with a superior knowledge of ever-changing regulations and the new high-tech tools necessary to manage them. Former reporting tools are not capable of supporting the data requirements of tomorrow’s anesthesia healthcare. In order to stay in front of the curve and be competitive, anesthesia practices must invest in analytics specialists utilizing the most advanced technologies, processes and extensive healthcare expertise in analytical problem solving to alleviate inconvenience and costs and to maximize revenues.
Anesthesia Payer Contract Negotiations
Further, it should be noted that the transition to anesthesia informatics has placed an emphasis on payer contract negotiations in which anesthesia providers get paid for what they negotiate as opposed for what they bill. Therefore, it is important to employ experts who are well-versed in anesthesia payer contract negotiations and re-negotiations.
Anesthesia Coding Regulations
The new coding regulations require anesthesiologists to accept the premise of ICD-10 and collaborate with surgeons in determining proper post-operative diagnoses as payers will be able to use the information on the anesthesia claim to validate the surgical claim which could affect cash flow and denials.
To avoid major increases in denials and their impact on cash flow, anesthesia providers must learn new terminology and alter how they record the diagnostic approval for surgical procedures performed. The logic and the level of detail required vary greatly from one surgical procedure to another. Again, anesthesiologists serve their best interests through working alongside analytics specialists to decrease the possibility of denials and to insure increased revenue.
The American Healthcare Information Management Association (AHIMA) supports the new codes and their potential benefits which includes improved data capture and analytics to advance healthcare delivery and policies; increased capacity to stay current with healthcare changes and delivery that advance service, efficiency, safety and results; enhanced patient care based on a better understanding of new procedures, progressive disease management and clarity regarding patient outcomes.
PQRS, EMRs, QCDR Awareness
Based on a goal of achieving improved benchmarks for measuring the quality and propriety of care, the Centers for Medicare and Medicaid Services (CMS) introduced the Physician Quality Reporting System (PQRS) to implement quality standards specific to anesthesia.
Electronic medical records (EMRs) have been introduced to transition from the unwieldy PQRS with the intention of improving coordination among anesthesia providers, switching from claims-based reporting to registry reporting.
For anesthesiologists who simply want to focus on the patients in their care, all of these new regulations and requirements can appear daunting and complicated. The progression of documentation requirements next relates to the Qualified Clinical Data Registry (QCDR), for which the Anesthesia Quality Institute’s (AQI) QCDR is perhaps the most significant anesthesia registry. There are other registry options available to anesthesia practices, but AQI QCDR will most likely be the preferred choice.
The purpose of the QCDR is to deduce the quality of care provided by anesthesiologists from measuring their performance in all phases of anesthesia care. The AQI’s QCDR list includes 41 measures from which each practice will choose nine measures to report. The measures are grouped into the person and caregiver-centered experience, patient safety, communication and care coordination, community and population health and effective clinical care – of which three must be represented by the measures selected, which are further grouped into process and outcomes measures.
QCDR reporting will also reflect a change in submission methods. Currently, PQRS measures are included on Medicare claims as CPT codes. The plan is to switch to a registry-based reporting system whereby the measures will be sent to CMS, thereby creating another level of provider coordination for each practice.
Anesthesiology Billing Services Recommended
With the fast-paced changes taking place in the provision of anesthesiology healthcare today, it is recommended that anesthesiology practitioners stay ahead of the curve through enlisting the help of specialists in anesthesia informatics.