Set Up Concurrency Rules for Anesthesia Billing
The Concurrency Rules tab on the Anesthesia Library Payer Maintenance window enables you to define parameters related to concurrency audit rules, charge split percentages, unit price, contractual adjustments, rounding method, and minutes per unit.
For both split and non-split charges, 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
For split charges the extended price is split across the two resulting charge lines based on the percentages entered in the Medical Director and CRNA fields. After the charges are split, units are only used for reporting purposes. Units are not split, but remain whole on each charge line, effectively doubling the units.
Note: The total charge calculation is the same for split billing and non-split billing.
- On the Anesthesia Library Payer Maintenance window, select the Concurrency Rules tab.
- Use the table below to define Concurrency Rules parameters for the selected Valid Payers.
Field Description Concurrency Audit Rules Options: Max # of concurrent procedures Enter the maximum number of concurrent procedures that an anesthesiologist can oversee to bill as medical direction. This field is required. When the maximum number is met or exceeded, the Anesthesia Concurrency Audit report displays the following message: Max number of concurrent procedures exceeded. All effected concurrent procedures are marked as failed.
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 Select this option to identify 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. This option is selected by default.
Provider cannot perform two procedures at the same time Select this option to indicate that an anesthesia provider cannot personally perform two procedures at the same time. This option is selected by default.
Medical Director cannot perform and direct concurrently Select this option to indicate that an anesthesiologist cannot personally perform and provide medical direction at the same time.
This option is selected by default.
In Progress conversion hold days Do one of the following: - Leave 0 (default)
- 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.
Note: Encounters convert from In Progress to Unbilled when the date of service is less than or equal to the current date minus conversion hold days.Insert condition code for age in charges (patient must be > 1 year or < = 70 years old)
Select this option to automatically create a 99100 charge line with the same rendering MDA provider, diagnosis and location as the anesthesia charge. This option is selected by default.
Note:- A 99100 CPT code, effective for the date of service and marked as an Anesthesia QC (Qualifying Circumstance) code, must exist in the Service Items library.
- Only one instance of the 99100 can exist on a single encounter.
- When this option is enabled, the 99100 check box is automatically selected on the Charge Posting > Anesthesia Service Information window for the encounter.
Note: To create a 99100 charge in Charge Posting, you must open the Anesthesia Service Information window and select OK to save.Charge Split Percentage Options: Medical Director Do one of the following: - For non-split charges, leave as zero (0) or enter 100.
- 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.
Note: The sum of the percentages for medical director and CRNA must equal 100%.CRNA Do one of the following: - For non-split charges, leave at zero (0) or enter 100.
- 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.
Note: The sum of the percentages for medical director and CRNA must equal 100%.Unit Price Options: Default Unit Price Enter 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:- Override Unit Price on the SIM Options tab of the Anesthesia library
- Default Unit Price on the Concurrency Rules tab of the Anesthesia library
- Service Items Library > SIM Exceptions > Non-Facility/Facility Amount
- Non-Facility/Facility Price on the General tab of the Service Items library
Note: If the user manually enters an Override price during charge posting, it is used for the total charge amount regardless of the unit price derived from the above hierarchy.Contractual Adjustment Options: Contract Allowed Unit Price Enter the contractual allowed unit price for all anesthesia SIM codes for the selected payers. Note: A contractual allowed unit price for a specific SIM range can be entered on the SIM Options tab.Transaction Code Select the third-party adjustment transaction code to be used for contractual adjustments for the selected payers. Note: A transaction code for a specific SIM range can be selected on the SIM Options tab.Anesthesia Rounding Method Options: Anesthesia Rounding Method The default Anesthesia Rounding Method is defined for each individual payer on the Payers > Defaults-2 tab.
If the rounding method should be different from the above for the selected payers, select one of the following:- Always Round Down
- Always Round Up
- Exact units to the first decimal place
- Exact units to the second decimal place
- Round Down at 4 Up at 5
- Round Down at 7 Up at 8 (default)
Anesthesia Minutes per Unit Options Anesthesia Minutes per Unit Enter 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:- Minutes Per Timespan for SIM range on the SIM Options tab of the Anesthesia library
- Minutes Per Unit for SIM range on the SIM Options tab of the Anesthesia library
- Minutes Per Unit on the Concurrency Rules tab of the Anesthesia library
- Anesthesia Minutes per Unit on the Defaults-2 tab of the Payers master file
- To save changes and close the window, select OK.