understanding the value of crna services how to figure out what you are worth
TRANSCRIPT
Understanding the Value of CRNA ServicesHOW TO FIGURE OUT WHAT YOU ARE WORTH
Missouri Association of Nurse AnesthetistsState Reimbursement SpecialistsSallie M. Poepsel PhD,CRNAJeanie Skibiski, MHA, DNAP (c) CRNA
OBJECTIVES
• Describe the relationship between CPT and the RVG
• Determine the monetary value of anesthesia services
• Using available app(s) compute the billable anesthesia charges and projected reimbursement given select case scenarios
DEFINITIONS
• CPT: Current Procedural Terminology
• RVG: Relative Value Guide
• TM: Time Modifiers; 15 min. = 1 unit
DEFINITIONS
• MODIFIERS: physical status; age,
events
• CF: Conversion Factors or Cost/Unit
CPT CODES: Examples
• 00836 INGUINAL HERNIORRHAPHY• 00790 LAP. CHOLECYSTECTOMY• 00740 EGD• 00560 CABG• 01382 R KNEE ARTHROSCOPY• 01402 L TOTAL KNEE REPLACEMENT• 00600 C4-5,C5-6 MICRODISCECTOMY
RVG BASE UNITS for CPTs
• 00560 CABG 15 + TM
• 01382 R KNEE ARTHROSCOPY 7 + TM
• 00600 C4-5,C5-6 MICRODISCECTOMY 10 + TM
CASE SCENARIO
A 45 year-old female ASA II underwent an elective lap. cholecystectomy. Anesthesia start time was 0715; after completion of the surgery, patient was transferred to PACU @ 0815. The CRNA after giving report ended anesthesia time @ 0820.
Compute Billable Units
• RVG code for Lap. Cholecystectomy: 00790
CPT Code: 38100• Base units using the RVG: _____• Time Units: _____• Modifiers: _____• Total Units: _____
ANESTHESIA BILLABLE UNITS
• 1) Determine the RVG code• 2 Find corresponding Base Unit• 2) Determine the TM• 3) Identify other modifiers if any• 4) Compute the total anesthesia units
Compute Billable Units
• RVG code for laparoscopic Cholecystectomy: • Base units using the RVG: 7• Time Units: 4.3• Modifiers: 0• Total Units: 11.3
TOTAL ANESTHESIA CHARGES
• 5) Determine the Conversion Factor (CF) for the
CPT:
Insurance provider: BCBS, Aetna,
Healthlink
Medicare
Total Anesthesia Charges
• Total Anesthesia Billable Units: • Conversion Factor: $50.00/unit x 11.3 total
units• TOTAL CHARGES: $ 565.00
GROUP WORK
• Group I • Group II• Group III
Case Scenario # 1
• A 55 year-old female with stable HTN, smoker, has GERD and a BMI of 39. Had exploratory lap - total abdominal hysterectomy with anesthesia time lasting from 1005-1205.
• Payor Mix: Mercy CF: $ 60/unit
Case Scenario # 2
• A 55 year-old female ASA II who underwent lap assisted vaginal hysterectomy BSO. Total anesthesia time 3 hours.
• Payor Mix: GHP; CF: $72/unit
Case Scenario # 3
• A 70 year-old male, with COPD, DM, Hyperlipidemia and HTN. Had total knee arthroplasty with anesthesia time from 0807 hrs. to 1039 hrs.
• Payor Mix: Medicare; CF: $22.74/unit
End-of-year
PAYOR MIX: Medicare = $22.74 (450 cases) 12 units
GHP = $72.00 (100 cases) 8 units
Mercy = $60.00 ( 98 cases) 14 units
BC/BS = $75.00 (132 cases) 10 units
TOTAL……780 cases)
Anesthesia Charges
• MEDICARE: 5400 units X $22.74 = $122,796.00• GHP : 800 units X $72.00 = $ 57,600.00• Mercy : 1372 units X $60.00 = $ 82,320.00• BC/BS : 1,320 units X $75.00 = $ 99,000.00
TOTAL….. $ 361,716.00
CRNA Compensation
BASE SALARY $ 145,000.00
BENEFITS:
6 wks ETO (336 X 69.71) $23,422.56
Profit Sharing $14,000.00
Professional liability insurance: $ 7,200.00
AANA membership fee: $ 645.00
TOTAL PACKAGE: $190,267.56
Comparative Analysis
• REVENUE GENERATED: $ 361,716.00• TOTAL COMPENSATION: $
190,267.56
Case Scenario
• 68 yr old male with ventral hernia repair; smoker, HTN• Procedure takes one hour• Medicare coverage• Conversion factor(CF) = $20.00/unit.
Case Con’t
• CPT: 00832 Ventral hernia• Base Units: 6 units• Time: 1 hr: 4 units• Total units: 10 units x 20.00/unit = $200.00
(Medicare pays 80% = $160.00)
(Patient pays 20% = $ 40.00)
Case Con’t
• Medicare case 1 hour• Turn around time 30 minute; + 30 minute lunch• 15 min breaks x 2• No of cases you can do: 5 cases/day• 5 cases x $200.00 = $1000.00 (generated/day)
Case Con’t
• What if you only did Medicare cases?
365 days/year = 52 weeks
- 5 weeks vacation = 25 days
- 1 week misc. time
- work 5 days/week + call x 46 weeks
= 5 x 1000/day = 5000 x 46 = $230,000.00
JUST DOING MEDICARE CASES
Case Con’t
• Therefore: 230K 30% usually would cover benefits
161K + benefits
Bare minimum if you only do Medicare cases!!!
THANK YOU