Author: Tony Miru
For doctors who medically direct, their primary focus should be the room or rooms they are overseeing. Nevertheless, national and local Medicare rules allow the medically directing doctor to perform certain other services, as well. What are these services and are they applicable in every jurisdiction? Today’s alert provides answers.
There is always, it seems, an exception to every rule—an “exception that proves the rule.” It’s always “i” before “e,” except after “c,” right? You can turn right on red, except in those jurisdictions that don’t allow it. Exceptions to rules are pervasive throughout our daily life, and they exist in the anesthesia world, as well.
The General Rule
A large number of our anesthesia groups are composed of both anesthesiologists and anesthetists—and many of these utilize a medical direction model. For those groups that medically direct, the doctors are already aware that they must meet the so-called “seven elements,” as required by national Medicare rules. There is also the general requirement that you cannot be involved in any activity other than focusing on the cases you are directing. Here’s how the Medicare Claims Processing Manual (MCPM), Ch 12, Sec 50, puts it:
A physician who is concurrently furnishing services that meet the requirements for payment at the medically directed rate cannot ordinarily be involved in furnishing additional services to other patients.
That’s the general rule. It is the government’s intent, then, that medically directing doctors should be focusing their attention exclusively on the cases under their direction, while not personally performing other patient services. Indeed, personally performing a case would normally “break” one’s medical direction status. However, as we’ve noted above, there are often exceptions to every rule.