Explain TEFRA

From the AANA website:

TEFRA are a set of conditions an anesthesiologist must meet if s/he is to bill Medicare for medical direction of a CRNA and thereby claim 50% of the anesthetic fee. There are 7 of these "steps" that an anesthesiologist must follow if s/he wants to bill Medicare Part B for the anesthetic given by a CRNA.

These 7 steps include:

1. Pre-op assessment

2. Prescribe the Plan of Care

3. Personally participate in induction/emergence

4. Ensure that everything else is done by pro-

fessionals

5. Monitor the patient at frequent intervals

6. Be readily available to help treat emergencies

7. Provide post operative care

I'm in an ACT facility and our MDAs should be following the TEFRA rules in order for their group to bill for services under Medicare Part B. Do they always do all 7? No. They're pretty good at pre-op, readily available to help tx emergencies, post-op care, prescribing the anesthetic (ie..regional or general or MAC. They don't actually tell us what to use or how to do it) and of course we, the CRNAs are the professionals left to do the case after they leave. Our MDAs are there for induction but are never there for emergence and they really don't make "frequent checks" on the patients. If we need them, they'll come. MDAs seem to bill for medical direction even if they don't follow all 7 rules.

Hope that helps. Check out the AANA site under the Gov't Relations link.

Thanks so much -- that helped a lot!

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