Wiki MD verusus CRNA reimbursement

[lblanchette]

What is the rule of thumb as a payer when I receive an Anesthesiologist/MD bill along with the CRNA bill what is the correct method to reimburse them ? Is there something written stating this is the way we are to reimburse both (md & crna) is it half and half? or the Anesthesiologist 100% and the CRNA 50%? I am trying to set up guidelines for this but I cannot find anything giving me plain and simple logic of how this should be done. Please help me to determine what is correct and simple way to figure this out..

 

[jdrueppel]

lblanchette,

Are you asking from a payer or provider stand point? Not that it matters but by the way you pose the question it would appear you are a payer.

It depends on how the service is billed. MDAs can personally perform, medically supervise, or medically direct. CRNAs can personally perform (if allowed by state where service was performed CRNA licensure scope of service), be medically supervised or be medically directed. It comes down to the documentation, concurrency and the modifier reported on the services. See HCPCS modifiers AA, AD, QZ, QX, QK, QY. The CMS manual has a description of each of these billing scenarios as well as % of payment guidelines that apply to each modifier. I have attached to CMS Anesthesia Chapter link below. See page 117.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

Julie, CPC