Getting the split right
In a care-team model, the anesthesiologist and CRNA each bill their part of a medically directed case. Whether a case counts as medically directed depends on the seven medical direction requirements and on how many cases the anesthesiologist was covering at once.
What we check
- Concurrency ratios at each point in the day
- Documentation for each of the seven requirements
- Matching QK or QY and QX claims for each case
- Cases that should fall back to medical supervision (AD) or non-directed (QZ)
Why it matters
Bill a case as medically directed without the documentation and you risk paying money back. Bill it as supervised when it was really directed and you leave money behind. We aim for the version the record supports.
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