CRNA Supervision vs. Medical Direction

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Hospital or surgical facility administrators seeking to learn more about anesthesia billing and staffing models are smart to educate themselves on the ins and outs of supervision vs. medical direction related to anesthesia care. Although CRNA supervision vs. medical direction seems simple in concept, there are many important details to consider when determining the suitable model for your facility and maintaining billing compliance.

Is Medical Supervision Better than Medical Direction?

As an administrator, your primary questions surrounding CRNA supervision vs. medical direction should be focused on maintaining proper compliance for either model. If you cannot meet the seven requirements for achieving medical direction, you will be using the medical supervision modifier. Your anesthesia management group should help you better understand which staffing model is best for your facility and ensure all requirements are being met for whichever model is chosen. In some situations, an all-CRNA practice may even make the most sense.

Requirements for Medical Direction

Medical direction occurs when an anesthesiologist directs the delivery of anesthesia care from up to four CRNAs doing concurrent cases. To legally achieve medical direction, the anesthesiologist must meet seven billing requirements. These requirements are set forth by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). 

Seven Documentation Requirements for Medical Direction

An anesthesiologist must meet all seven of these documentation requirements for every case he or she is concurrently medically directing:

  • Perform a pre-anesthetic examination and evaluation
  • Prescribe the anesthesia plan
  • Personally participate in the most demanding procedures in the anesthesia plan, including induction and emergence 
  • Ensure a qualified individual performs any procedures in the anesthesia plan that the anesthesiologist does not personally perform 
  • Monitor the course of anesthesia administration at frequent intervals 
  • Remain physically present for all key and critical portions of the procedure and be available for immediate diagnosis and treatment of emergencies
  • Provide post-anesthesia care as indicated

Requirements for Medical Supervision 

Medical supervision applies when a physician is overseeing more than four CRNAs who are concurrently administering anesthesia care. There are no requirements for the physician to provide hands-on care; instead, the physician is available to assist in any of the concurrent cases. In 18 states, there are no physician supervision requirements for CRNAs which means CMS can still reimburse facilities without physician supervision of CRNAs. 

Are You Maintaining Anesthesia Billing Compliance? 

If you are overcome with worry after reading the seven requirements for medical direction, give us a call. Medical direction does pose risks, and you should be confident that your anesthesia department is compliant. Whether medical direction, medical supervision or a CRNA-only practice is right for you, CCI Anesthesia can expertly manage it in efficient ways that support any bottom line. 

Contact us today at 800.494.3948 to learn more about CRNA supervision vs. medical direction.