Understanding the Value of CRNA Services HOW TO FIGURE OUT WHAT YOU ARE WORTH
Missouri Association of Nurse Anesthetists State Reimbursement Specialists Sallie M. Poepsel PhD,CRNA Jeanie 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 INGUINAL HERNIORRHAPHY LAP. CHOLECYSTECTOMY EGD CABG R KNEE ARTHROSCOPY L TOTAL KNEE REPLACEMENT C4-5,C5-6 MICRODISCECTOMY
RVG BASE UNITS for CPTs CABG 15 + TM R KNEE ARTHROSCOPY 7 + TM 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 The CRNA after giving report ended anesthesia 0820.
Compute Billable Units RVG code for Lap. Cholecystectomy: CPT Code: 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: $
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 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, GHP : 800 units X $72.00 = $ 57, Mercy : 1372 units X $60.00 = $ 82, BC/BS : 1,320 units X $75.00 = $ 99, TOTAL….. $ 361,716.00
CRNA Compensation BASE SALARY $ 145, BENEFITS: 6 wks ETO (336 X 69.71) $23, Profit Sharing $14, Professional liability insurance: $ 7, AANA membership fee: $ TOTAL PACKAGE: $190, BASE SALARY $ 145, BENEFITS: 6 wks ETO (336 X 69.71) $23, Profit Sharing $14, Professional liability insurance: $ 7, AANA membership fee: $ TOTAL PACKAGE: $190,267.56
Comparative Analysis REVENUE GENERATED: $ 361, 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: Ventral hernia Base Units: 6 units Time: 1 hr: 4 units Total units: 10 units x 20.00/unit = $ (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 $ = $ (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, 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