Billing question



  1. Is there any advantage to a hospital to have MDAs on staff instead of CRNAs? My understanding is that Medicare reimburses at the same rate for both professions, so why would a hospital have a MDA that has to be paid 3X what a CRNA makes? And the other side of that is why do MDAs make so much more than CRNAs? I have read on line that normally a CRNA being supervised by a MDA split the fee 50/50, but why is the CRNA willing to give up that 50% is they do not need to be supervised?



    [font='Times New Roman']Follow-up question is about insurance. Is a CRNA practicing independently charged the same insurance as a MDA practicing independently in the same area?
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  2. 17 Comments

  3. by   trakstar
    Please see previous post from today regarding reimbursement. You must look deep into the medicare rules. Reimbursement rates grossly go as follows. MDA independently 100%, CRNA independently 85%, MDA supervising AA (up to 4 cases stimultaneously) MDA 50% for each case & AA 50%. MDA supervising CRNA (up to 4 cases stimultaneously) MDA 50% for each case & CRNA 50%.
  4. by   user69
    Thanks for the information. Any insight into the isurance part?
  5. by   Trauma Tom
    TRAKSTAR,

    Do these same rates of reimbursement for medicare apply to private insurance? If not it appears that the only benefit to using AA's is in cases where Medicare is involved. I am assuming however, that private insurance must follow the same rules. What about medicaid? Also, I am wondering why more CRNA's do not practice in rural areas. If I am doing the math correctly, assuming a 50% reimbursement rate for the CRNA with MDA supervision or direction, versus 85% without which I am assuming would apply to most rural areas would mean a CRNA could conceivably earn 170% of what he or she would make working with an anesthesiologist. Am I missing something? Or do you have fewer cases in rural areas that diminish the billable hours available?


    Quote from trakstar
    Please see previous post from today regarding reimbursement. You must look deep into the medicare rules. Reimbursement rates grossly go as follows. MDA independently 100%, CRNA independently 85%, MDA supervising AA (up to 4 cases stimultaneously) MDA 50% for each case & AA 50%. MDA supervising CRNA (up to 4 cases stimultaneously) MDA 50% for each case & CRNA 50%.
  6. by   jwk
    Quote from trakstar
    Please see previous post from today regarding reimbursement. You must look deep into the medicare rules. Reimbursement rates grossly go as follows. MDA independently 100%, CRNA independently 85%, MDA supervising AA (up to 4 cases stimultaneously) MDA 50% for each case & AA 50%. MDA supervising CRNA (up to 4 cases stimultaneously) MDA 50% for each case & CRNA 50%.
    At least you see that the reimbursement rates are the same. And yes, the same holds true for private insurors and Medicaid.
  7. by   trakstar
    Trauma Tom...

    I'm not sure that I understand your question. Maybe this will clarify. All anesthesia is billable. If we looked at the same case and only changed who was administering the anesthesia the reimbursement for that anesthesia from medicare would also change. If an MDA performed the case they would be reimbursed 100% for their services when working independently. Looking sat the same case with the same anesthesia given by an CRNAindependently and not an MDA medicare reimburses the CRNA only 85% hence the lower salary of the CRNA versus MDA. Now if we look at reimbursement with supervision with an MDA supervising either an AA or CRNA the CRNA or AA split the medicare reimbursement cost with the MDA 50/50. However an MDA in this circumstance can supervise up to 4 rooms splitting the reimbursement costs 50/50 in each which allows them to collect twice the billable hours than working independently. If you have an other questions please ask. These numbers I caution are gross. Different institutions pay differently making the MDA, CRNA and AA's salary not soley dependent on medicare reimbursement.
  8. by   Brenna's Dad
    This is not my understanding of how reimbursement works. I await another response from a seasoned member.

    It is my understanding that medicare reimburses the same for each case regardless of who performs the anesthesia.

    What a shocker if they didn't.
  9. by   trakstar
    Thanks for being so blunt and a bit insulting. Seasoned member or not look at the medicare reimbursement rates and analyze them yourself. The despairities are there. Since you seem to have a better grasp on the concept please enlighten me. I warned you that the example was grossly correct on the numbers. The numbers I have are from my health policy class from a teacher who has a PhD from UCSF in health policy and worked with clinton of overhauling health care policy. Medicare is not fair nor an exact science it is reality. An Addendum according to the 2004 medicare reimbursement fee schedule for non medically directed CRNAs, the conversion rate is the same as the MDA. This is new for 2004. The information I had was based on the 2002 rates. However the medically directed CRNA still splits there fee 50/50 with the MDA who can supervise up to 4 cases. I do not know if the reimbursement is different with regards the the ICD-9 codes and how these are effect which base units are allotted for each case which in the end ultimately effects your reimbursement. The point in the end is that it behooves MDAs to medically supervise CRNAs. This is quite difficult when we can practice independently hence we have the creative genius of the ASA who spawned the AAs. If you research the history of AAs the ASA created them from their early infancy. If you'd like to more from a rookie let me know it is quite an interesting story and will shed even more light on this soap opera of a story.
    Last edit by trakstar on May 21, '04
  10. by   jwk
    Quote from trakstar
    Thanks for being so blunt and a bit insulting. Seasoned member or not look at the medicare reimbursement rates and analyze them yourself. The despairities are there. Since you seem to have a better grasp on the concept please enlighten me. I warned you that the example was grossly correct on the numbers. The numbers I have are from my health policy class from a teacher who has a PhD from UCSF in health policy and worked with clinton of overhauling health care policy. Medicare is not fair nor an exact science it is reality. An Addendum according to the 2004 medicare reimbursement fee schedule for non medically directed CRNAs, the conversion rate is the same as the MDA. This is new for 2004. The information I had was based on the 2002 rates. However the medically directed CRNA still splits there fee 50/50 with the MDA who can supervise up to 4 cases. I do not know if the reimbursement is different with regards the the ICD-9 codes and how these are effect which base units are allotted for each case which in the end ultimately effects your reimbursement. The point in the end is that it behooves MDAs to medically supervise CRNAs. This is quite difficult when we can practice independently hence we have the creative genius of the ASA who spawned the AAs. If you research the history of AAs the ASA created them from their early infancy. If you'd like to more from a rookie let me know it is quite an interesting story and will shed even more light on this soap opera of a story.
    If you want to know the history of AA's, ask an AA. They were NOT created by the ASA.

    The Medicare splits for MD's and anesthetists are not new. They've been around in some form since the mid-80's. And I remember when they came around that a lot of MD's did NOT like it - there were a lot of group practices around with a single anesthesiologist covering a dozen rooms with CRNA's. They were all making a ton of money and would like to have kept it that way.

    Funny how a discussion that started about reimbursement deteriorates into AA bashing.
  11. by   Trauma Tom
    JWK,

    Allright how about some history. Who started AA practice and if not created by the ASA to increase their potential incomes then who started the practice? And how did they gain entry into the field in the first place? I do not wish to bash AA's but rather obtain accurate information about their history. I have heard discussions in the past about anesthesiologist's income and know that it has decreased greatly over what it was in the 80's. I am assuming that managed care affected their incomes and wonder if some of their income has been diverted to CRNA's. Obviously if in the past one anesthesiologist could cover 12 rooms with CRNA's then they could not be present for supervision or direction, at least not to the extent covered by today's rules. (assumption) Also, could they cover twelve rooms of AA's back in those days? If so, has your scope of practice been curtailed as a result of changes concerning supervision? And by law were you able to do things in the past that you are not able to do today, or has hospital policy restricted your practice? Have AA's compensation mirrored CRNA's compensation in the past as well, or has it remained fairly constant, correcting for inflation? How do you feel about anesthesiologists being able to cover 12 rooms? Do you agree with the present supervision laws or would you prefer to return to the old ways? Rather than bash each other it might be interesting to see if we have some common ground that could enhance all of our practices. Wouldn't that be a twist on the present discusion? Please no attacks, I really want accurate information, not inflamed rhetoric! Thanks for your input in advance.


    Quote from jwk
    If you want to know the history of AA's, ask an AA. They were NOT created by the ASA.

    The Medicare splits for MD's and anesthetists are not new. They've been around in some form since the mid-80's. And I remember when they came around that a lot of MD's did NOT like it - there were a lot of group practices around with a single anesthesiologist covering a dozen rooms with CRNA's. They were all making a ton of money and would like to have kept it that way.

    Funny how a discussion that started about reimbursement deteriorates into AA bashing.
  12. by   Sheri257
    Nevermind.
    Last edit by Sheri257 on May 22, '04
  13. by   Brenna's Dad
    Didn't mean to be insulting. There are a few people on this board that have been practicing anesthesia for over 20 years and are very informed with regards to the reimbursement rules. (not that I'm saying you aren't).

    It seems that in your last post (if I am reading it correctly) that you agreed with me in saying that reimbursement for anesthesia is the same regardless of provider? Of course, I agree that it behooves the MDA to supe cases rather than perform them since they can effectively receive 200% compensation.
    Last edit by Brenna's Dad on May 21, '04
  14. by   loisane
    Quote from Brenna's Dad
    This is not my understanding of how reimbursement works. I await another response from a seasoned member.

    It is my understanding that medicare reimburses the same for each case regardless of who performs the anesthesia.

    What a shocker if they didn't.
    I have to agree with Brenna's Dad, that my understanding is that reimbursement is the same under Medicare rules. This is something AANA accomplished quite some time ago, and it has been very significant in the development of our profession.

    There is a section on the AANA website that explains Medicare billing. I am sorry I do not have time to look for it now, as I am out of town. It is a complicated subject, so it helps to have sources that can break it down to understandable level.

    loisane crna

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