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