Guidelines for Qualified Non-Physician Anesthetist Billing

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Guidelines for Qualified Non-Physician
Anesthetist Billing

• Certified Registered Nurse Anesthetists (CRNAs)
  and Anesthesiologists Assistants are considered
  as qualified non-physician anesthetists for
  purpose of anesthesiology billing. In this
  article, we shared general billing guidelines and
  payment for qualified non-physician anesthetist
  billing. As most insurance carriers adhere to
  Medicare billing guidelines, we referred Medicare
  claims processing manual chapter 12. You are
  advised to refer to payer-specific guidelines for
  actual reimbursement and appropriate selection of
  modifiers. Before diving into billing guidelines,
  lets understand Medicares definition of an
  Anesthesiologists Assistant and Certified
  Registered Nurse Anesthetists (CRNAs).
• Anesthesiologists Assistant
• An anesthesiologists assistant means a person
  who
• Works under the direction of an anesthesiologist
• Is in compliance with all applicable requirements
  of State law, including any licensure
  requirements the state imposes on non-physician
  anesthetists and
• Is a graduate of a medical school-based
  anesthesiologist assistant educational program
  that

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Guidelines for Qualified Non-Physician
Anesthetist Billing

• Is accredited by the Committee on Allied Health
  Education and Accreditation and
• Includes approximately two years of specialized
  basic science and clinical education in
  anesthesia at a level that builds on a premedical
  undergraduate science background.
• Certified Registered Nurse Anesthetists (CRNAs)
• A CRNA is a registered nurse who
• Is licensed as a registered professional nurse by
  the State in which the nurse practices
• Meets any licensure requirements the State
  imposes with respect to non-physician
  anesthetists
• Has graduated from a nurse anesthesia educational
  program that meets the standards of the Council
  on Accreditation of Nurse Anesthesia Programs
  and
• Meets the following criteria
• Has passed a certification examination of the
  Council on Certification of Nurse Anesthetists or
  the Council on Recertification of Nurse
  Anesthetists or

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Guidelines for Qualified Non-Physician
Anesthetist Billing

• Is a graduate of a nurse anesthesia educational
  program that meets the standards of the Council
  of Accreditation of Nurse Anesthesia Educational
  Programs, and within 24 months of graduation, has
  passed a certification examination of the Council
  on Certification of Nurse Anesthetists or the
  Council on Recertification of Nurse Anesthetists
• Guidelines for Qualified Non-Physician
  Anesthetist Billing
• CRNAs and anesthesiologists assistants may bill
  Medicare directly for their services or have
  payment made to any individual or entity (such as
  a hospital, critical access hospital, physician,
  group practice, or ambulatory surgical center)
  with which the CRNA or anesthesiologists
  assistant has an employment or contractor
  relationship that provides for payment to be made
  to the individual or entity. Claims with
  qualified non-physician anesthetist billing
  should be completed in accordance with existing
  billing instructions for anesthesiologists with
  the following additions
• If an employer-physician furnishes concurrent
  medical direction for a procedure involving CRNAs
  and the medical direction service is unassigned,
  the physician should bill on an assigned basis on
  a separate claim for the qualified non-physician
  anesthetist service. If the physician is
  participating or takes an assignment,

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Guidelines for Qualified Non-Physician
Anesthetist Billing

• both services should be billed on one claim
  but as separate line items.
• All claims forms must have the provider billing
  number of the qualified non-physician anesthetist
  and/or the employer of the qualified
  non-physician anesthetist performing the service
  in either block 24.H of the form CMS-1500 and/or
  block 31 as applicable. Verify that the billing
  number is valid before making payment. A CRNA is
  identified on the provider file by specialty code
  43. An anesthesiologists assistant is identified
  on the provider file by specialty code 32.
• Payment for Qualified Non-physician Anesthetists
• Payment for the services furnished by qualified
  non-physician anesthetists are subject to the
  usual Part B coinsurance and deductible and are
  made only on an assignment basis. The assignment
  agreed to by the qualified non-physician
  anesthetist is binding upon any other person or
  entity presenting a claim or request for payment
  for the service.
• The fee schedule for anesthesia services
  furnished by qualified non-physician anesthetists
  is the applicable locality-adjusted anesthesia
  conversion factor multiplied by the sum of
  allowable base and time units. The anesthesia
  locality-adjusted conversion factors are updated
  by the update factor used

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Guidelines for Qualified Non-Physician
Anesthetist Billing

• to update physicians services under the
  physician fee schedule. They are generally
  published in November of the year preceding the
  year in which they apply.
• The allowance for an anesthesia service furnished
  by a qualified non-physician anesthetist that
  meets the requirements for payment at the
  medically directed rate is based on a fixed
  percentage of the allowance recognized for the
  anesthesia service personally performed by the
  physician alone.
• The anesthesia locality-adjusted conversion
  factor for anesthesia services furnished by a
  CRNA that does not meet the requirements for
  payment at the medically directed rate may not
  exceed the allowance for a service personally
  performed by a physician.
• Anesthesia time means the time during which a
  qualified non-physician anesthetist is present
  with the patient. It starts when the qualified
  non-physician anesthetist begins to prepare the
  patient for anesthesia services in the operating
  room or an equivalent area and ends when the
  qualified non-physician anesthetist is no longer
  furnishing anesthesia services to the patient,
  that is, when the patient may be placed safely
  under post-operative care. Anesthesia time is a
  continuous time period from the start of
  anesthesia to the end of an anesthesia service.
  In counting anesthesia time, the qualified
  non-physician anesthetist can add blocks of time
  around an interruption in anesthesia time as long
  as the qualified non-physician anesthetist is
  furnishing continuous anesthesia care within the
  time periods around the interruption.

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Guidelines for Qualified Non-Physician
Anesthetist Billing

• The following modifiers are used by qualified
  non-physician anesthetists when billing for
  anesthesia services
• QX Qualified non-physician anesthetist service,
  with medical direction by a physician.
• QZ CRNA service, without medical direction by a
  physician.
• QS Monitored anesthesia care services. Note that
  the QS modifier can be used by a physician or a
  qualified non-physician anesthetist and is for
  informational purposes. Providers must report
  actual anesthesia time and one of the payment
  modifiers on the claim.
• Medical Billers and Coders (MBC) is a leading
  medical billing company providing complete
  medical billing and coding services. We shared
  billing Guidelines and payment details for
  qualified non-physician anesthetist billing for
  provider education purposes.
• For appropriate anesthesiology billing and
  coding, you are advised to refer to
  payer-specific billing guidelines and
  reimbursement policies. If you need any
  assistance with anesthesiology billing, call us
  at 888-357-3226 or email us at info_at_medicalbille
  rsandcoders.com.
•  
• Reference Medicare Claims Processing Manual
  Chapter 12
•