Friday, August 12, 2016

Anesthesia claim payment process

Anesthesia claims are paid based on the following: 

Time units + Base unit x Anesthesia Conversion factor. Neighborhood uses the Centers for Medicare and Medicaid Services (CMS) base unit values.

· Anesthesia Personally Performed by Anesthesiologist or CRNA (AA or QZ Modifier) (Total Time Units + Base Unit) x Anesthesia Conversion Factor x Modifier Adjustment = Allowance

· Anesthesia Performed under Medical Direction (QK, QX and QY modifiers) [(Total Time Units + Base Unit) x Anesthesia Conversion Factor] x Modifier Adjustment = Allowance for each provider

Anesthesia start time is defined as the time the anesthesiologist begins the preparation of the patient. Anesthesia end time is defined as the time when the patient is placed under post-operative care. Time anesthesiologist is not in personal attendance is non-billable.

Do not submit base unit values in the total minutes or units field on a claim. Base units are automatically calculated and paid in Neighborhood reimbursement

Calculating Time Units for Anesthesia Services and Rounding

Submit 1 unit for every 15-minute interval, rounding up to the next unit for 8 to 14
minutes, rounding down for 1 to 7 minutes.

Number of Minutes Service is Provided Number of Units to Bill

7 minutes or Less Do not Bill
8 minutes to < 23 minutes 1 unit
23 minutes to < 38 minutes 2 units
38 minutes to < 53 minutes 3 units
53 minutes to < 68 minutes 4 units
68 minutes to < 83 minutes 5 units
83 minutes to < 98 minutes 6 units
98 minutes to < 113 minutes 7 units
113 minutes to < 128 minutes 8 units

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