decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 4 (April)
CMS corrects value for 00797 – be sure private payers follow
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Article Overview
This article explains a Medicare anesthesia valuation correction and why practices should verify whether private payers updated their pricing systems accordingly. It is relevant to anesthesia coders, billing staff, and revenue cycle teams that work with Medicare-based payment methodologies and payer file updates. The discussion covers the timing of the CMS correction, the role of the ASA, and the need to review prior claims for affected periods.
Why This Topic Matters
Payer systems may not always reflect current Medicare valuation changes at the same time, which can affect reimbursement if private carriers rely on Medicare-based pricing. The article helps practices recognize a potentially outdated fee schedule value and assess whether prior claims or payer systems need review.
What You Will Learn
- How a Medicare anesthesia valuation change can affect other payers
- Why payer file updates may lag behind CMS corrections
- What types of claim periods may need review after a fee schedule change
- How professional advocacy and CMS updates can intersect in anesthesia reimbursement
Who Should Read This
- Anesthesia coders
- Medical billers
- Revenue cycle staff
- Practice managers
- Anesthesia practice administrators
Codes Discussed
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