Understanding TEFRA and Its Impact on Anesthesia Services

Established in 1982, the Tax Equity and Fiscal Responsibility Act (TEFRA) is a federal law that aims to reduce the federal budget deficit through a combination of tax increases, spending cuts and budgetary reforms.

TEFRA’s Impact on Anesthesia Practices

TEFRA regulations are far-reaching across various industries. In the healthcare field, TEFRA specifically affects anesthesia practices. Here, we’ll explore how TEFRA changed anesthesiology billing and anesthesia service definitions and how the Act has affected the workload of anesthesiologists and CRNAs.

How TEFRA Changed Anesthesia Payment Methodology

TEFRA requirements for anesthesia established the Anesthesia Fee Schedule, which created guidelines for Medicare payments for anesthesia services. The schedule calculates payments based on a formula that includes both base units (used to represent the complexity and the time that the procedure is performed) and time units (used to represent the actual amount of time that anesthesiology professionals spend completing the procedure).

TEFRA differentiates between medical direction and medical supervision of anesthesia services. The reimbursement of anesthesiologists who supervise Certified Registered Nurse Anesthetists (CRNAs) hinges on this distinction.

Here’s the difference between the two:

• Medical Direction: An anesthesiologist is considered to be medically directing if they are involved in no more than four concurrent anesthesia cases, perform certain vital tasks (like performing a pre-anesthesia examination and evaluation, prescribing the anesthesia plan and monitoring the course of anesthesia administration) and remain available to provide immediate care if needed. Under medical direction, the anesthesiologist and CRNA/AA share the payment.
• Medical Supervision: If an anesthesiologist oversees more than four concurrent cases or does not meet the specific requirements for medical direction, it is considered medical supervision. This generally results in lower reimbursement rates for the anesthesiologist compared to medical direction.

Key Takeaways for Medical Direction Under TEFRA

Anesthesia professionals prefer the medical direction designation over the medical supervision designation. Let’s explore the requirements for medical direction.

Pre-Anesthetic Examination and Evaluation

The anesthesiologist must perform and document a pre-anesthetic evaluation. The examination aims to discover any medical conditions or risk factors affecting patient outcomes. During this evaluation, the anesthesiologist performs a medical history review and a physical examination, which may include an airway assessment. The anesthesiologist may also order lab tests to determine if there are any special considerations for the patient. Finally, the anesthesiologist interviews the patient to discuss the risks and benefits of the anesthesia process.

Anesthesia Plan and Participation

To qualify for medical direction, the anesthesiologist must develop, document and participate in the anesthesia plan. The anesthesiologist must participate in the most demanding aspects of the plan, such as induction and emergence from anesthesia. The anesthesiologist must also ensure the patient is continually monitored throughout the procedure.

Documentation Requirements for Compliance

Comprehensive documentation is vital throughout each step of the TEFRA process, from detailing the pre-anesthesia patient interview to post-anesthesia care. Properly conducting and documenting each step of the medical direction process (especially the pre-anesthetic examination and evaluation) directly impacts the reimbursement rates the anesthesiologist will receive from Medicare.

Challenges in Meeting TEFRA Requirements

Several challenges can make it tough to qualify for medical direction under TEFRA requirements, including:

• Concurrent case limit: TEFRA mandates that each anesthesiologist can only direct four concurrent cases at a time. In busy practices, it can be challenging for anesthesiologists to stay within the four-patient limit.
• Documentation: Meticulous documentation is required for TEFRA, and ensuring that all documentation is submitted on time can be difficult for busy anesthesia staff.
• Qualified personnel: It’s essential that qualified individuals complete all procedures and that each of these individuals understands TEFRA requirements.

Patient Safety and Quality of Care

Staying within the limits of TEFRA requires extreme attention to detail, which can lead to improved patient outcomes. Reducing caseloads can also prevent anesthesia professionals from overworking, reduce burnout and increase career satisfaction.

As an anesthesiologist, it’s critical to stay aware of TEFRA requirements. Be sure to utilize reputable resources to maximize the Medicare reimbursement you get for your services.

How CCI Anesthesia Can Streamline Your Anesthesia Department

Managing anesthesia services can be challenging, from meeting compliance requirements to maximizing reimbursement. CCI Anesthesia ensures your department runs smoothly, stays compliant and boosts revenue with our expertise.

Ready to streamline your anesthesia services? Contact CCI Anesthesia at 844.937.1810 to learn how we can help.