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Related Concept Videos

Methods of Documentation VI: Case Management Model01:15

Methods of Documentation VI: Case Management Model

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The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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A matrix model for valuing anesthesia service with the resource-based relative value system.

David R Sinclair1, David A Lubarsky1, Michael M Vigoda1

  • 1Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.

Journal of Multidisciplinary Healthcare
|October 23, 2014
PubMed
Summary

A new anesthesia billing model using the resource-based relative value system (RBRVS) was proposed. This RBRVS model better values complex cases and could double Medicare reimbursement, while remaining revenue-neutral for commercial insurers.

Keywords:
billingcrosswalkpayment reform

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Area of Science:

  • Anesthesiology
  • Health Economics
  • Medical Billing

Background:

  • Current anesthesia billing methods may not accurately reflect the complexity of care provided.
  • The resource-based relative value system (RBRVS) offers a framework for valuing medical services.

Purpose of the Study:

  • To propose and evaluate a novel RBRVS-based billing system for anesthesia services.
  • To preserve the time unit component and disaggregate billing into preoperative, intraoperative, and postoperative components.

Main Methods:

  • Observational chart and billing data review of 1,195 patients (ASA physical status 1-5).
  • Comparison of proposed RBRVS payments with current American Society of Anesthesiologists (ASA) relative value guide (RVG) payments.
  • Analysis of payment differences for commercial insurers and Medicare.

Main Results:

  • Strong correlations (r=0.94-0.96) were found between proposed RBRVS and current ASA RVG payments.
  • The proposed RBRVS model resulted in 3.0% lower payments than commercial insurers.
  • Medicare reimbursement could nearly double under the RBRVS model, with greater increases for complex anesthetic management.

Conclusions:

  • The proposed RBRVS crosswalk is revenue-neutral for commercial insurers and aligns with evaluation and management codes.
  • The new system better values care for complex patients and complex surgeries.
  • This RBRVS model more accurately represents the true value of anesthetic case management.