Many people believe that Opt out would not change practice models, just billing style. However, not true. Below is a great post by a CRNA on the issue.
In fact the change in billing style DOES change the anesthesia practice model.
Anesthesia Practice models are primarily identified by billing methodolgy. ACT
- identifies the model in which an MDA must meet TEFRA rules (billing rules). IF
the MDA doesn't have to run around and sign paperwork.. the model is now more
Collaborative/Consultative. IMO, that is a move in the right direction.
The increase in utilization of QZ modifier for CRNA services and less emphasis
on TEFRA rules helps those CRNAs in what was the ACT model to do their own thing
without an MDA coming along to poke his head in make some
ridiculous adjustment in the anesthesia based on the 2 minutes he is in the
room. BIG NOTE: the folks in this anesthesia department could not do this with
I wonder if any CRNAs that work in an ACT that tries or fakes TEFRA
rules would appreciate a system where their services were billed QZ.. and didn't
require the MDA to come around and provide his/her "expertise" on a regular
AND are you saying that changing the billing, eliminating the need for meeting
TEFRA guidelines is not a step in the right direction???!!! I would recommend
an article written in Outpatient Surgery magazine by a CRNA... :0)
It starts out by saying:
Medicare Billing for Anesthesia Done Right
Jay Horowitz, President
Medicare billing fraud is a phrase you'll never want to hear, much less see, in
a formal document delivered to your practice or facility. Yet in no area are the
billing rules and laws more arcane and more fraught with peril than those that
dictate the proper billing of anesthesia services.
In my mind, the Opt Out which we originally thought would help only the rural
sector actually seems to help ease issues in the larger urban areas as well...
an interesting side effect. It's not the end all and it's not a fast movement
but things are changing.