August 01, 2011
New Regulation Regarding Reporting of Anesthesia Time
As part of the transition to the 5010 HIPAA electronic claims standards, a universal system for reporting anesthesia time to all payers will go into effect January 1, 2012. This new standard will require all anesthesia time to be reported in minutes instead of units - the current norm for some commercial (private) payers.
For more than a decade ASA was able to successfully prevent this change through its lobbying activity; however the change is now going into effect. During each stage of the lobbying on this issue, ASA has consistently communicated with members that, “No one should be surprised at further attempts by X12N and the payers to eliminate our ability to round anesthesia time.” (American Society of Anesthesiologists Newsletter, June 2003, Volume 67, Number 6).
This change may result in some payers attempting to move from a full unit to a fractional unit payment system. A move from a full unit to fractional unit system would likely benefit some and cost other anesthesia providers depending on when the individual contracts permit rounding to the next unit. The bottom line is that any changes to commercial payment contracts will have to be negotiated between anesthesiologists and commercial providers. Anesthesiologists should be aware of this change when negotiating contracts with payers. The change to the reporting standard does not prohibit payers/providers contracts from rounding to the nearest whole unit when determining payments.
More information about the transition to the 5010 format.