# Billing for CRNA performing Aline or CVP



## erincm76 (Dec 15, 2017)

Our CRNA's are employed the hospital and while working under Medical Direction of our attending Anesthesiologist, they may need to perform supplemental procedures such as Aline insertion or CVP's, which I understand fall under the medical direction guidelines as part of the entire anesthesia plan.  But it has come up from an external auditing company that we should be billing for these procedures under the CRNA's name and not the attending even though the attending was present in the OR at the time of the procedure and has met all other "medical direction" requirements.

My group does not agree with this, so I am trying to find out how everyone else bills for such circumstances.  Do you pull those procedures off the attending's claim and submit a claim for the CRNA's services?  Or do you submit it all under the attending as part of the full scope of anesthesia services?


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## thomas7331 (Dec 15, 2017)

The auditors are correct - if you have been billing CRNA services under the attending anesthesiologist, you're essentially billing their services as 'incident to' which under CMS rules is not allowed in a facility setting.  In a facility, all professional services must be billed under the credentials of the provider who actually performed the work.  By billing CRNA services under the physician's credentials, Medicare would reimburse these claims at 100% of the PFS instead of the 85% which would be the correct rate for a mid-level provider and you have likely been overpaid for your CRNA services and will need to reimburse Medicare for these overpayments.  If that is the case, you will need to act quickly on this since it has been brought up by your auditors and you may be under a time requirement to refund these payments to Medicare from the date that this was identified.


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