Anesthesia and CRNA billing question?

Q. Why has Blue Cross made a decision to contract with CRNAs and AAs?
Healthcare Reform Provider Non-discrimination PPACA § 1201; PHSA § 2706(a) NON-DISCRIMINATION IN HEALTH CARE requires that group health plans and health insurers shall not discriminate against health care providers acting within the scope of their license or certification under the laws of the state of Alabama. In order to be in compliance, Blue Cross reviewed all provider types to ensure that providers covered under this provision could file claims. Changes were necessary for CRNAs and AAs.

Q. If a CRNA is already enrolled with Blue Cross, does he or she need to reapply for the CRNA Network?
Yes, having a provider number and being “credentialed” for the networks are not the same thing. All providers applying for network participation with any network must go through the same process.

Q. What is required to apply for the CRNA Network?
Providers must complete the Physician Extender Application, all supporting forms, and provide the requested documentation. Missing forms or required documentation will slow down the credentialing process.

Q. Will the Federal Employee Program (FEP) CRNA Network remain in place?
Effective January 1, 2014, the new CRNA Network will replace any existing networks, including the FEP CRNA Network.

Q. Will groups exclude CRNAs as eligible providers?
No, groups will no longer exclude CRNAs as eligible providers

Q. How were the services provided by CRNAs/AAs reimbursed previously?
Blue Cross traditionally reimbursed physicians for the services provided by CRNAs/AAs under an “incident to” arrangement. Hospital-employed CRNAs/AAs were reimbursed directly by the hospital. Anesthesiologists employing a CRNA/AA were reimbursed through the physician claim and received an extra unit for the cost of employment and were paid on 15-minute time units. Anesthesiologists that used hospital-employed CRNAs did not receive an extra unit and were paid on 30-minute time units.

Q. Will the anesthesiologist employing CRNAs/AAs still receive an extra unit?
Effective for services rendered on or after January 1, 2014, employing CRNAs/AAs will not result in any extra units added to the anesthesia calculations. Time units will all be calculated based on 15-minute units.

Q. Will the anesthesiologist using hospital-employed CRNAs/AAs have 30-minute time units?
No, all anesthesia time calculations will be based on 15-minute time units.

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