Concurrency Audit Rules Fields Description
| Field | Description |
|---|---|
| Max # of concurrent procedures | Enters the maximum number of concurrent procedures that an anesthesiologist can oversee to bill as medical direction. Entering a maximum number, allows you to modify the charge entry information to allow the encounter to pass the audit. |
| Payer considers same start and stop time as concurrent | Identifies the same start and stop time as concurrent. For example, if one procedure ends at 8:00 AM and another procedure starts at 8:00 AM, then the Anesthesia Concurrency Audit identifies these procedures as concurrent. |
| Provider cannot perform two procedures at the same time | Indicates that an anesthesia provider cannot personally perform two procedures at the same time. |
| Medical Director cannot perform and direct concurrently | Indicates that an anesthesiologist cannot personally perform and provide medical direction at the same time. |
| In Progress conversion hold days | You can leave 0 (default) or enter a number that indicates the number of days that In Progress encounters must be held before they can be converted to Unbilled status for billing.
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| Insert condition code for age in charges (patient must be > 1 year or < = 70 years old) | Automatically creates a 99100 charge line with the same rendering MDA provider, diagnosis and location as the anesthesia charge.
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| Charge Split Percentage Options: | |
| Medical Director | You can leave as zero or enter 100 for non-split charges and for split charges enter the percentage of the total anesthesia charge to apply to the anesthesiologist. This percentage is applied to the Medical Director charge during the Anesthesia Concurrency Audit. The charge amount displays in Charge Posting after the charge is released for billing with the audit. |
| CRNA | You can leave at zero (0) or enter 100 for non-split charges and for split charges enter the percentage of the total anesthesia charge to apply to the CRNA. This percentage is applied to the CRNA charge during the Anesthesia Concurrency Audit. The charge amount displays in Charge Posting after the charge is released for billing with the audit. |
| Unit Price Options: | |
| Default Unit Price | Enters the default unit price for all anesthesia SIM codes for the selected payers. The total charge amount is determined by multiplying the unit price by the total anesthesia units. Base Units + Time Units + Modifier Units = Total Anesthesia Units Total Anesthesia Units x Unit Price = Total Charge Amount
Unit Price may also be defined in other areas. When an anesthesia charge is entered, the following hierarchy (highest to lowest) is used to determine the Unit Price for the charge:
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| Contractual Adjustment Options: | |
| Contract Allowed Unit Price | Enters the contractual allowed unit price for all anesthesia SIM codes for the selected payers.
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| Transaction Code | Selects the third-party adjustment transaction code to be used for contractual adjustments for the selected payers.
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| Anesthesia Rounding Method Options: | |
| Anesthesia Rounding Method | The default Anesthesia Rounding Method is defined for each individual payer on the tab.
If the rounding method should be different from the above for the selected payers, select one of the following:
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| Anesthesia Minutes per Unit Options | |
| Anesthesia Minutes per Unit | Sets the number of minutes per unit for the selected payers. Maximum setting is 9999.
Minutes per Unit may also be defined in other areas. When an anesthesia charge is entered, the following hierarchy (highest to lowest) is used to determine the Minutes per Unit for the charge:
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