Does this practice/location rent or own its space?

Rent: A tenant who makes regular payments to a landlord for the use of property in which practice is located.

Own: The practice or hospital/IDS owns the space in which the practice is located
 

How many years has this practice/location been open?

Enter the number of years this practice/location has been open regardless of changes made to the name, ownership, organization structure, tax identification number (TIN), practice NPI etc.
 

What accounting method was used for tax reporting purposes?

Cash: An accounting system where revenues are recorded when cash is received and costs are recorded when cash is paid out. Receivables, payables, accruals, and deferrals arising from
operations are ignored. On a pure cash basis, long-lived (fixed) assets are expensed when acquired, leaving cash and investments as the only assets, and borrowings and payroll withholds as the only liabilities.

Accrual: An accounting system where revenues are recorded as earned when services are performed rather than when cash is received. Cost is recorded in the period during which it is incurred, that is, when the asset or service is used, regardless of when cash is paid. Costs for goods and services that will be used to produce revenues in the future are reported as assets and recorded as costs in future periods. The accrual system balance sheet includes not only the assets and liabilities from the cash basis balance sheet but also includes the receivables from patients, prepayments and deferrals of costs, accruals of costs and revenues, and payables to suppliers.
 

What accounting method was used for internal management purposes?

Cash: An accounting system where revenues are recorded when cash is received and costs are recorded when cash is paid out. Receivables, payables, accruals and deferrals arising from
operations are ignored. On a pure cash basis, long-lived (fixed) assets are expensed when acquired, leaving cash and investments as the only assets, and borrowings and payroll withholds as the only liabilities.

Modified Cash: An accounting system that is primarily a cash basis system, but allows the cost of long-lived (fixed) assets to be expensed through depreciation. The modified cash system recognizes inventories of goods intended for resale as assets. Under a modified cash system, purchases of buildings and equipment, leasehold improvements, and payments of insurance premiums applicable to more than one accounting period are normally recorded as assets. Costs for these assets are allocated to accounting periods in a systematic manner over the length of time the practice benefits from the assets.

Accrual: An accounting system where revenues are recorded as earned when services are performed rather than when cash is received. Cost is recorded in the period during which it is incurred, that is, when the asset or service is used, regardless of when cash is paid. Costs for goods and services that will be used to produce revenues in the future are reported as assets and recorded as costs in future periods. The accrual system balance sheet includes not only the assets and liabilities from the cash basis balance sheet but also includes the receivables from patients, prepayments and deferrals of costs, accruals of costs and revenues, and payables to suppliers.
 

Did your practice provide ancillary/supplementary services? Such services are those that are provided as part of, or are wholly owned by the practice.

Ancillary services are those services that supplement the routine (professional) services personally performed by the practice’s provider staff. Such services are billed under separate CPT codes and reimbursed separately, either by third-party payers and/or patients.

Advanced radiology: Examples of such services include but are not limited to mammography, CT, MRI, nuclear medicine, ultrasound, bone densitometry, cardiac catheterization lab, ECP, MRA, EMG, and EEG.

Aesthetics and cosmetic services: Examples of such services include but are not limited to Botox, laser hair removal, skin care, and vein removal.

Allergy/Asthma/Immunology: Examples of such services include allergy injections, pulmonary function tests, and vaccinations.

Ambulatory surgery center: An ambulatory surgery center (ASC) is specifically licensed to provide surgery services performed on a same-day outpatient basis, including endoscopy centers. Select if your practice or physicians owned or had financial interest in an ASC as part of, or wholly owned by the practice. Do not select if the ASC is a separate legal entity.

Audiology/Hearing Aid(s)/Center: Examples of such services include hearing aids and centers where audiology tests take place.

Clinical laboratory services: (tests of high complexity under CLIA): Select if your practice provided lab tests of high complexity as determined under CLIA. Do not select if your practice performed only tests of waived or moderate level complexity under CLIA.

Clinical research/drug studies: Select if your practice participated and provided services under a clinical/drug trial study or research program.

Complementary alternative medicine: Examples of such services include but are not limited to massage therapy, acupuncture, and acupressure.

Drug administration: Examples of such services include, but are not limited to, chemotherapy.

Durable Medical Equipment (DME): Examples of such products include but are not limited to hearing aids, orthotics, diabetic meters and supplies, aids to daily living, and orthopedic supplies.

General radiology: Examples of such services include general and routine X-rays.

Health education/counseling services: Select if your practice provided billable services for health education and guidance to patients related to diet, weight control, diabetes, physiological, and/or genetic counseling.

Optical shop: Select if your practice or physicians owned or had financial interest in an optical service shop. Do not select if that optical shop is a separate legal entity.

PT/OT/Cardiac rehabilitation: Examples of therapies and testing that pertain to these lines of services include biofeedback and phase II cardiac rehabilitation.

Radiation therapy: Examples of such services include but are not limited to radiotherapy and X-ray therapy.

Sleeping lab/center: Examples include sleep studies or polysomnogram.

Other: Indicate any other ancillary services provided by your practice in the space provided.
 

Gross fee-for-service charges (do not include capitation charges) [4100-4130]11

The full value, at the practice’s undiscounted rates, of all services provided to fee-for-service, discounted fee-for-service, and noncapitated patients for all payers.
Include:

• Professional services provided by physicians, advanced practice providers, and other physician extenders such as nurses and medical assistants;

• Both the professional and technical components (TC) of laboratory, radiology, medical diagnostic, and surgical procedures;

• Drug charges, including vaccinations, allergy injections, immunizations, and chemotherapy and anti-nausea drugs;

• Charges for supplies consumed during a patient encounter inside the practice’s facilities. Charges for supplies sold to patients for consumption outside the practice’s facilities are reported as a subset of “Revenue from the sale of medical goods and services”;

• Facility fees. Examples of facility fees include fees for the operation of an ambulatory surgery unit or fees for the operation of a medical practice owned by a hospital where split billing for professional and facility services is utilized;

• Charges for fee-for-service services allowed under the terms of capitation contracts;

• Charges for professional services provided on a case-rate reimbursement basis; and

• Charges for purchased services for fee-for-service patients. Purchased services for fee-for-service patients are defined as services that are purchased by the practice from external providers and facilities on behalf of the practice’s fee-for-service patients.

• The revenue for such services should be included in “Total net fee-for-service collections/ revenue”;

• The cost for such services should be included, as appropriate, in “Clinical laboratory,” “Radiology and imaging” or “Other ancillary services”; and

• The count of the number of purchased procedures for fee-for-service patients should be included in the Production tab, Number of Procedures column.

Do not include:

• Charges for services provided to capitation patients. Such charges are included in “Gross charges for patients covered by capitation contracts”;

• Charges for pharmaceuticals, medical supplies and equipment sold to patients primarily for use outside the practice. Examples include prescription drugs, hearing aids, optical goods, orthopedic supplies, etc. The revenue generated by such charges is included in “Revenue from the sale of medical goods and services”; or

• Charges for any other activities that generate the revenue reported in “Revenue from the sale of medical goods and services.”

Adjustments to fee-for-service charges (value of services performed for which payment is not expected) [4200- 4240, 4500-4600]11

The difference between “Gross fee-for-service charges” and the amount expected to be paid by or back to patients or third-party payers. This represents the value of services performed for which payment is not expected.
Include:

• Medicare/Medicaid charge restrictions (the difference between the practice’s full, undiscounted charge and the Medicare limiting charge);

• Third-party payer contractual adjustments (commercial insurance and/or managed care organization);

• Charitable, professional courtesy or employee adjustments; and

• The difference between a gross charge and the Federally Qualified Health Center (FQHC) payment. This could be a positive or negative adjustment.

⭐Adjusted fee-for-service charges

Bad debts due to fee-for-service activity (accounts assigned to collection agencies) [6900-6920]11

The difference between “Adjusted fee-for-service charges” and the amount actually collected.
Include:

• Losses on settlements for less than the billed amount;

• Accounts written off as not collectible;

• Accounts assigned to collection agencies; and

• In the case of accrual accounting, the provision for bad debts.

Gross charges for patients covered by capitation contracts [4170]11

Also known as fee-for-service equivalent gross charges. The full value, at a practice’s undiscounted rates, of all covered services provided to patients covered by all capitation contracts, regardless
of payer.
Include:
Fee-for-service equivalent gross charges for all services covered under the terms of the practice’s capitation contracts, such as:

• Professional services provided by physicians, advanced practice providers, and other physician extenders such as nurses and medical assistants;

• Both the professional and technical components (TC) of laboratory, radiology, medical diagnostic, and surgical procedures;

• Drug charges, including vaccinations, allergy injections, immunizations, and chemotherapy and antinausea drugs;

• Charges for supplies consumed during a patient encounter inside the practice’s facilities. Charges for supplies sold to patients for consumption outside the practice’s facilities are reported as a subset of “Revenue from the sale of medical goods and services”; and

• Facility fees. Examples of facility fees include fees for the operation of an ambulatory surgery unit or fees for the operation of a medical practice owned by a hospital where split billing for professional and facility services is utilized.

Do not include:

• Pharmaceuticals, medical supplies, and equipment sold to patients primarily for use outside the practice. Examples include prescription drugs, hearing aids, optical goods, orthopedic supplies, etc. If such goods are not covered under the capitation contract, the revenue from these charges is included in “Revenue from the sale of medical goods and services”;

• The value of purchased services from external providers and facilities on behalf of the practice’s capitation patients. The cost of these purchased services is included in “Purchased services for capitation patients”;

• Charges for fee-for-service activity allowed under the terms of capitation contracts. Such charges are reported as “Gross fee-for-service charges”; or

• Capitation revenue. If capitation charges are not tracked, leave space blank.

⭐ *Total net fee-for-service collections/revenue [4300-4330, 4350-4420]11

Report the total technical and professional net fee-for-service revenue.

If the practice used accrual basis accounting, “Total net fee-for-service collections/revenue” should equal “Gross fee-for-service charges” less “Adjustments to fee-for-service charges,” less “Bad debts due to fee-for-service activity.”
 

Gross capitation revenue (per member per month capitation payments, capitation patient copayments) [4700-4770]11

Revenue received in a fixed per member payment, usually on a prospective and monthly basis, to pay for all covered goods and services due to capitation patients.
Include:

• Per member per month capitation payments including those received from an HMO, Medicare AAPCC (average annual per capita cost) payments, state capitation payments for Medicaid beneficiaries, and capitation payments from other medical groups;

• Portions of the capitation withholds returned to a practice as part of a risk-sharing arrangement;

• Bonuses and incentive payments paid to a practice for good capitation contract performance;

• Patient copayments or other direct payments made by capitation patients;

• Payments received due to a coordination of benefits and/or reinsurance recovery situation for capitation patients; and

• Payments made by other payers for care provided to capitation patients.

Do not include:

• Payments paid to a practice by an HMO under the terms of a discounted fee-for-service managed care contract. Such payments are included in “Total net fee-for-service collections/revenue.”
   

Purchased services for capitation patients [7810-7828]11

Fees paid to healthcare providers and organizations external to the practice for services provided to capitation patients under the terms of capitation contracts.
Include:

• Payments to providers outside the practice for physician professional, advanced practice provider, clinical laboratory, radiology and imaging, hospital inpatient and emergency, ambulance, out of area emergency and pharmacy services; and

• Accrued expenses for “incurred but not reported” (IBNR) claims for purchased services for capitation patients for which invoices have not been received.
   

Net capitation revenue

Subtract “Purchased services for capitation patients” from “Gross capitation revenue.”
 

Incentive-based revenue [4800-4860]11

Payments received from insurance companies and government agencies for incentive-based activities such as pay-for-performance, risk-sharing, shared savings, quality, and technology.
Include:

• Pay-for-performance payments for reporting quality, efficiency, or patient satisfaction metrics for patients insured under fee-for-service payment contracts;

• Risk pool insurance;

• Shared savings payments (i.e. Accountable Care Organization (ACO));

• Incentive payments for adopting Certified EHR Technology and/or meeting quality standards (i.e. MACRA/MIPS)
   

Other medical revenue [4900-4950,4970]11

Other sources of medical revenue such as grants, research/clinical studies, educational subsidies, donations, honoraria and more.
Include:

• Payments received for the reproduction of patient records;

• Medical directorship revenue received by the practice and not a specific individual for providing medical administration to hospitals, skilled nursing facilities, long-term care facilities, and other healthcare organizations;

• Grant revenue from federal, state, or local government or private foundation grants for research, provision of patient care to the indigent, or case management of the frail and elderly;

• Research and clinical studies revenue from pharmaceutical studies, medical device studies, and other research activities conducted by the practice;

• Educational subsidies received by the practice for graduate medical education and training of medical, nursing, and medical technician students;

• Any endowment or gift received by the organization;

• Revenue for medical-related activities such as honoraria, educational seminars, expert witness testimonies;

• Payment to the practice for physicians working in a hospital emergency room;

• Contract revenue from a school district for physician services in conducting physical examinations or other service;

Do not include:

• Charges for the delivery of services made possible by subsidies or grants were included in “Gross fee-for-service charges” and/or “Gross charges for patients covered by capitation contracts”; or

• Operating and nonoperating subsidies received from a parent organization such as a hospital, health system, PPMC, or MSO. Such items should be included in, "Financial support from parent organization (subsidies)”; or

• Paycheck Protection Program (PPP) loan forgiveness payment. Such items should be included in, “Extraordinary nonmedical revenue.”
   

Revenue from the sale of medical goods and services [4340-4349]11

Include income from the sale of medical products and revenue paid to the practice for professional services provided by practice physicians and staff members.
Include:

• Revenue from pharmaceuticals, medical supplies and equipment sold to patients primarily for use outside the practice. This amount should be net of write-offs and discounts. Examples include prescription drugs, hearing aids, optical goods, orthopedic supplies, etc.;

• Compensation paid by a hospital, skilled nursing facility, or insurance company to a practice physician for services as a medical director;

• The hourly wages of physicians working in a hospital emergency room;

• Contract revenue from a hospital for physician services in staffing a hospital indigent care clinic or emergency room;

• Contract revenue from a school district for physician services in conducting physical exams for high school athletes;

• Revenue from the preparation of court depositions, expert testimony, postmortem reports, and other special reports; and

• Fees received from patients for the photocopying of patient medical records.

Do not include:

• Capitation revenue used to pay for covered goods and services for capitation patients. Such revenue is included in “Gross capitation revenue.”
   

Gross revenue from other medical activities

Add "Incentive-based revenue," “Other medical revenue,” and “Revenue from the sale of medical goods and services.”
Do not include:

• Interest income, which is reported as “Nonmedical revenue”;

• Income from practice nonmedical property such as parking areas or commercial real estate, which is reported as “Nonmedical revenue”;

• Income from business ventures such as a billing service or parking lot, which is reported as “Nonmedical revenue”;

• One time gains from the sale of equipment or property, which is reported as “Nonmedical revenue”; or

• Cash received from loans, which is not reported anywhere in this survey.
   

Cost of sales and/or cost of other medical activities [7900-7919]11

Cost of activities that generate revenue included in “Revenue from the sale of medical goods and services,” as long as this cost is not also included in “Total operating cost” or “Nonmedical cost.”
Include:

• Cost of pharmaceuticals, medical supplies and equipment sold to patients primarily for use outside the practice. Examples include prescription drugs, hearing aids, optical goods, and orthopedic supplies; and

• Any provider consultant cost(s) within this question total.

Do not include:

• Cost of drugs used in providing services including vaccinations, allergy injections, immunizations, chemotherapy, and anti-nausea drugs. Such cost is included in “Drug supply”; or

• Cost of medical/surgical supplies and instruments used in providing medical/surgical services. Such cost is included in “Medical and surgical supply.”

Net other medical revenue

Subtract “Cost of sales and/or cost of other medical activities” from “Gross revenue from other medical activities.”
 

⭐*Total medical revenue

Add “Total net fee-for-service collections/revenue,” “Net capitation revenue,” and “Net other medical revenue.”
 

Nonmedical revenue (investment and rental revenue) [9100-9140, 9160-9170, 9190]11

Include:

• Interest and investment revenue such as interest, dividends, and/or capital gains earned on savings accounts, certificates of deposit, securities, stocks, bonds, and other short-term or long-term investments;

• Gross rental revenue such as rent or lease income earned from practice-owned property not used in practice operations;

• Capital gains on the sale of practice real estate or equipment, etc.;

• Interest paid by insurance companies for failure to pay claims on time;

• Bounced check charges paid by patients; and

• Gross revenue from business ventures such as a billing service or parking lot. The direct costs of such ventures should be reported as “Nonmedical cost.”

Do not include:

• Cash received from loans, which is not reported anywhere in this survey.

Extraordinary nonmedical revenue [9150, 9700]11

Revenue that is unusual in nature and infrequent in occurrence.
Include:

• Legal settlement receipts;

• Environmental disaster recovery funds;

• Paycheck Protection Program (PPP) loan forgiveness payment.

Do not include:

• Revenues included in “Nonmedical revenue”.
   

Financial support from parent organization (subsidies) [4960, 9180]11

Medical practices may receive financial support from a parent organization such as a hospital, health system, PPMC, or MSO.
Include:

• Operating subsidy income provided to the practice from a parent organization such as a hospital, health system, PPMC, or MSO;

• Nonoperating subsidy income received from parent organization such as a hospital, health system, PPMC, or MSO. (i.e. Capitalization projects such as facility construction)

Do not include:

• Payments received by the practice and not a specified individual for providing medical administration to hospitals, skilled nursing facilities, long-term care facilities, and other healthcare organizations. Such items should be included in, “Other Medical Revenue.”
   

Goodwill amortization [9250]11

When an IDS, hospital, or PPMC purchases a medical practice, the purchase price can be thought of as having two components — the value of the tangible assets and the value of the goodwill.
Goodwill is the premium paid in excess of the value of the tangible and identifiable intangible assets. If financial statements are maintained in accordance with the income tax basis of accounting, goodwill may be amortized over a period of time. If financial statements are reported in accordance with generally accepted accounting principles, goodwill is periodically reviewed for impairment. The tangible and identifiable intangible assets are typically depreciated/amortized over a period of time. For this question, report the annual amortization or impairment cost of goodwill.

Do not include:

• Depreciation of tangible or identifiable intangible assets such as the building or equipment. These depreciation costs are reported as a component of “Information technology” cost, “Building depreciation” cost, “Furniture and equipment depreciation” cost, “Clinical laboratory” cost, “Radiology and imaging” cost, and “Other ancillary services” cost.
   

Nonmedical cost (income taxes) [9200-9210, 9230-9240, 9260, 9300-9530]11

Include:

• Income taxes based on net profit that is paid to federal, state, or local government. For cash basis accounting, income taxes equal the cash payment or refund for the 2020 tax year paid or received in 2020 plus periodic withholding paid for 2020 taxes during 2020. For accrual accounting, the income tax equals the total tax liability for 2020 regardless of when the tax was paid or refunds were received;

• All costs required to maintain the productivity of income producing rental property and parking lots;

• Losses on the sale of real estate or equipment and losses from the sale of marketable securities;

• Other nonmedical cost;

• All direct costs related to business ventures such as rental property, parking lots, or billing services, for which gross revenue is reported as “Nonmedical revenue,” as long as these costs are not also included in “Total operating cost”; and

• State taxes on medical revenue.
   

Extraordinary nonmedical cost [9220, 9600, 9800]11

Cost that is unusual in nature and infrequent in occurrence.
Include:

• Legal settlement cost; and

• Environmental disaster recovery cost.

Do not include:

• Cost included in “Nonmedical cost.”
   

*Total ancillary support staff FTE and Cost [5140, 5240]11

Subtotal the FTE and cost for “Clinical laboratory,” “Radiology and imaging” and “Other medical support services.” Provide this total even if you are unable to provide all the variables requested in previous questions.
 

*Total employed support staff FTE and Cost [5100, 5200]11

Add “Total business operations support staff,” “Total front office support staff,” “Total clinical support staff,” and “Total ancillary support staff” answers.
 

*Total employed support staff benefit cost [5170, 5180, 5300-5460]11

The "Total employed support staff benefit cost” column should represent the total benefits for the FTE count of all employed support staff reported in “Total employed support staff” FTE column.
Include:

• Employer’s share of Federal Insurance Contributions Act (FICA), payroll and unemployment insurance taxes;

• Employer’s share of health, disability, life, and workers’ compensation insurance;

• Employer payments to defined benefit and contribution, 401(k), 403(b), and nonqualified retirement plans;

• Deferred compensation paid or expensed during the year;

• Dues and memberships in professional organizations, state, and local license fees;

• Allowances for education, professional meetings, travel, and automobile; and

• Entertainment, country/athletic club membership, travel for spouse.

Do not Include:

• Voluntary employee salary deductions used as contributions to 401(k) and 403(b) plans; or

• Expense reimbursements.
   

Cost allocated to medical practice from parent organization

When a medical practice is owned by a hospital, integrated delivery system, or other entity, the parent organization often allocates indirect costs to the medical practice. These indirect costs may have different names depending on the situation. Examples of alternative names are “shared services costs” or “uncontrollable costs.” These costs may be arbitrarily assigned to the medical practice, may be the result of negotiations between the practice and the parent organization, or the result of some sort of cost accounting system. Often, these indirect costs include a portion of the salaries of the senior management team of the parent organization, a portion of corporate human resources costs, or a portion of corporate marketing costs.

Depending on the type of cost, the cost may be allocated to the medical practice as a function of the ratio of medical practice FTE to total system FTE, the ratio of medical practice square footage to total system square footage, or the ratio of medical practice gross charges to total system gross charges. Depending on the culture of the integrated system, these indirect costs may or may not even show up on the financial statements of the medical practice.
Regardless of the cost’s name, the reporting culture or the cost allocation method, please try to identify these costs and report them.
Do not Include:

• Cash loans made to subsidiaries. Cash for loans does not appear anywhere on this survey.
   

*Total general operating cost

Add “Information technology” through “Cost allocated to medical practice from parent organization.”
 

⭐*Total operating cost

Add “Total support staff cost” and “Total general operating cost.”

Total physician benefit cost [8117-8118, 8120-8180,8217-8218, 8220-8280, 8317-8318, 8320-8380, 8617-8618, 8620-8680]11

The total benefits paid to physicians who comprise “Total physicians,” FTE column.
Include:

• Employer’s share of Federal Insurance Contributions Act (FICA), payroll, and unemployment insurance taxes;

• Employer’s share of health, disability, life, and workers’ compensation insurance;

• Employer payments to defined benefit and contribution, 401(k), 403(b), and nonqualified retirement plans;

• Deferred compensation paid or expensed during the year;

• Dues and memberships in professional organizations, state, and local license fees;

• Allowances for education, professional meetings, travel, and automobile; and

• Entertainment, country/athletic club membership, and travel for spouse.

Do not Include:

• Voluntary employee salary deductions used as contributions to 401(k) and 403(b) plans; or

• Expense reimbursements.
   

⭐*Total physicians

For “Total physicians” FTE, add “Primary care physicians,” “Nonsurgical specialty physicians,” and “Surgical specialty physicians,” FTE column. For “Total physicians” cost, add “Total physician compensation” and “Total physician benefit cost,” columns.
 

*Total providers

For “Total providers” FTE, add “Total advanced practice providers” and “Total physicians,” FTE column. For “Total providers” cost, add “Total advanced practice providers” and “Total physicians,” Cost column.

Accounts receivable

Provide the information regarding the age of your practice's accounts receivable (to the nearest whole dollar). Do not include accounts that have been assigned to collection agencies.
If your practice does not have any accounts receivable for a certain range, enter "0.”

⭐Current to 30 days

Amounts owed to the practice by patients, third-party payers, employer groups, and unions for fee-for-service activities before adjustments for anticipated payment reductions, allowances for adjustments, or bad debts. Amounts assigned to “Accounts receivable” are due to “Gross fee-for- service charges.” Assigning a charge into “Accounts receivable” initiates at the time a practice submits an invoice to the payer or patient for payment. For example, if an obstetrics practice
establishes an open account for accumulation of charges when a patient is accepted into a prenatal program and the account will not be invoiced until after delivery, then “Accounts receivable” will not reflect these charges until the creation of an invoice. Deletion of charges from “Accounts receivable” is done when the practice receives payment, turns over debt to a collection agency, or writes off the account as bad debt. “Accounts payable to patients and payers” are subtracted from “Accounts receivable” before reporting “Accounts receivable.”

This is the net amount owed after patient refunds.
Do not Include:

• Capitation payments owed to the practice by HMOs.

⭐31 to 60 days – See Current to 30 days.
⭐61 to 90 days – See Current to 30 days.
⭐91 to 120 days – See Current to 30 days.
⭐Over 120 days – See Current to 30 days.

⭐Total accounts receivable

Add “Current to 30 days,” “31 to 60 days,” “61 to 90 days,” “91 to 120 days,” and “Over 120 days.”
 

Did your practice re-age accounts receivable when a balance was transferred to a secondary carrier or the patient’s private account?

Answer “Yes” if accounts receivable were re-aged when a second insurance company or the patient was billed after the first insurance company refused to pay the entire billed amount.
 

Payer mix

Please estimate the percentage of your practice’s “Total gross charges” by type of payer. The sum of the percentages must add to 100 percent. If not applicable, please enter "0.”
Managed care: Managed healthcare is a system in which the provider of care is incentivized to establish mechanisms to contain costs, control utilization, and deliver services in the most appropriate settings.
There are three key factors:

• Controlling the utilization of medical services;

• Shifting financial risk to the provider; and

• Reducing the use of resources in rendering treatments to patients.

Capitation: Capitation is when a provider organization receives a fixed, previously negotiated periodic payment per member covered by the health plan in exchange for delivering specified healthcare services to the members for a specified length of time regardless of how many or how few services are actually required or rendered. Per member per month (PMPM) is the commonplace calculation unit for such capitation payments.
 

Medicare

Include all fee-for-service, managed care fee-for-service and capitated charges for all services provided to Medicare patients.

Medicare: fee-for-service: Fee-for-service gross charges, at the practice’s established undiscounted rates, for all services provided to Medicare patients on a fee-for-service basis. If patients are covered by both Medicare and Medicaid or a similar state healthcare plan, all charges for such patients should be included as Medicare fee-for-service charges.
Do not Include:

• Fee-for-service equivalent gross charges for services provided to Medicare/TEFRA (Tax Equity and Fiscal Responsibility Act) patients under capitated, prepaid or other “at-risk” arrangements.

Medicare: managed care fee-for-service: Fee-for-service gross charges, at the practice’s established undiscounted rates, for all services provided to Medicare patients through a managed care plan. If patients are covered by both Medicare and Medicaid or a similar state healthcare plan on a fee-for-service basis, all charges for such patients should be included as Medicare fee-for- service charges.
Include:

• Charges for patients covered under discounted fee-for-service contract arrangements.

Do not Include:

• Fee-for-service equivalent gross charges for services provided to Medicare/TEFRA (Tax Equity and Fiscal Responsibility Act) patients under capitated, prepaid arrangements.

Medicare: capitation: Fee-for-service equivalent gross charges, at the practice’s undiscounted rates, for all services provided to patients under a Medicare/TEFRA, received from a capitated contract.
Do not Include:

• Charges for fee-for-service patients; or

• Charges for patients covered under discounted fee-for-service contract arrangements.
   

Medicaid

Include all fee-for-service, managed care fee-for-service and capitated charges for all services provided to Medicaid or similar state healthcare program patients.

Medicaid: fee-for-service: Fee-for-service gross charges, at the practice’s established undiscounted rates, for all services provided to Medicaid or similar state healthcare program patients on a fee-for- service basis.
Do not Include:

• Fee-for-service equivalent gross charges for services provided to Medicaid or other state healthcare program patients under capitated, prepaid or other “at-risk” arrangements; or

• Charges for patients covered under discounted fee-for-service contract arrangements.

Medicaid: managed care fee-for-services: Fee-for-service gross charges, at the practice’s established undiscounted rates, for all services provided to Medicaid or similar state healthcare program patients under a managed care plan. If patients are covered by both Medicare and Medicaid or a similar state healthcare plan on a fee-for-service basis, all charges for such patients should be included as Medicare fee-for-service charges.
Include:

• Charges for patients covered under discounted fee-for-service contract arrangements.

Medicaid: capitation: Fee-for-service equivalent gross charges, at the practice’s undiscounted rates, for all services provided to Medicaid or similar state healthcare program patients under a
capitated contract.
Do not Include:

• Charges for fee-for-service patients; or

• Charges for patients covered under discounted fee-for-service contract arrangements.
   

Commercial

Include all fee-for-service, managed care fee-for-service and capitated charges for all services provided patients under a commercial capitated contact.

Commercial: fee-for-service: Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to fee-for-service patients who were covered by commercial contracts that do not include a withhold but may or may not include a performance-based incentive. A commercial contract is any contract that is not Medicare, Medicaid, or workers’ compensation.
Do not Include:

• Charges for Medicare patients;

• Charges for Medicaid patients;

• Charges for capitation patients;

• Charges for patients covered by a managed care plan;

• Charges for workers’ compensation patients;

• Charges for charity or professional courtesy patients; or

• Charges for self-pay patients.

Commercial: managed care fee-for-service: Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to patients who were covered by managed care contracts that do include a withhold and may or may not include a performance based incentive. A commercial contract is any contract that is not Medicare, Medicaid, or workers’ compensation.
Include:

• Charges for patients covered under discounted fee-for-service contract arrangements.

Do not Include:

• Charges for Medicare patients;

• Charges for Medicaid patients;

• Charges for capitation patients;

• Charges for workers’ compensation patients;

• Charges for charity or professional courtesy patients; or

• Charges for self-pay patients.

Commercial: capitation: Fee-for-service equivalent gross charges, at the practice’s undiscounted rates, for all services provided to patients under a commercial capitated contract.
Do not Include:

• Charges for fee-for-service patients; or

• Charges for patients covered under discounted fee-for-service contract arrangements.
   

Workers’ compensation

Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to patients covered by workers’ compensation insurance.
Do not Include:

• Charges for Medicare patients;

• Charges for Medicaid patients;

• Charges for charity or professional courtesy patients; or

• Charges for self-pay patients.
   

Charity care

Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to charity patients. Charity patients are patients not covered by either commercial insurance or federal, state, or local governmental healthcare programs and who do not have the resources to pay for services. Charity patients must be identified at the time that service is provided so that a bill for service is not prepared.
 

Self-pay

Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to patients who pay the medical practice directly. Note that these patients may or may not have insurance.
Include:

• Charges for patients who have no insurance but do have the resources to pay for their own care and do so; and

• Charges for patients who have insurance but choose to pay for their own care and submit claims to their insurance company directly. Since the practice may or may not be aware of this situation, all charges paid directly by the patient should be considered as self-pay.
   

Other federal government payers

Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to patients who are covered by other federal government payers other than Medicare.
Include:

• Charges for TRICARE patients.

Do not Include:

• Charges for Medicare and Medicaid patients.
   

*Total payer mix gross charges

The sum of the percentages for "Medicare," "Medicaid," "Commercial," “Workers’ compensation,” “Charity care,” “Self-pay” and “Other federal government payers” should equal 100%.
 

*Specify the number of Level 1, 2 and 3 trauma centers serviced

ANESTHESIOLOGY PRACTICES ONLY

If your group provides services to a level one, two, or three trauma center, specify the number of trauma centers serviced at each level in the boxes provided.
 

*Number of Hospital, Same-Day Surgery Center, Surgeon Offices and Other facilities staffed

ANESTHESIOLOGY PRACTICES ONLY

Indicate the number of facilities you covered in each facility type category. Please count any facilities not physically in the same location as separate facilities. For example, if you provide services (inpatient and outpatient) at one hospital in the same block of operating rooms, please count this as one facility. If the outpatient department is sufficiently removed that a separate staff is assigned to cover that “facility” on any given day, please count that as a separate facility (hospital or same day surgery center, as appropriate).
 

*Number of Hospital, Same-Day Surgery Center, Surgeon Offices and Other anesthetizing locations

ANESTHESIOLOGY PRACTICES ONLY

Indicate the number of anesthetizing locations including cath lab, ESWL, MRI, or OB suite, your practice covers at 7:30 AM (or another time that represents your typical first case of the day) in each facility type category. If one person “floats” to multiple places during the day such as MRI in the morning and cath lab in the afternoon within the same facility, please count this as one anesthetizing location. If some anesthetizing locations are not staffed daily, use partial numbers. For example, if you provide services at two hospitals and Hospital A has eight operating rooms (OR) and a cath lab where you provide services two days per week (0.4 anesthetizing locations) and Hospital B has 16 OR, an OB suite, an ESWL truck that comes twice per week (0.4 anesthetizing locations) and an MRI lab that you cover once per week (0.2 anesthetizing locations), you would list “2” as the number of facilities under “hospitals.” For hospital anesthetizing locations you would add the 8.4 (8 OR + 0.4 cath lab) at Hospital A and the 17.6 (16 OR + 1 OB + 0.4 ESWL + 0.2 MRI) at Hospital B to list a total of “26.” Recognizing that some facilities may have eight OR’s but only run six or seven on some days, include only those OR’s that you are committed to cover on a daily basis and exclude or use partial numbers for rooms that you only cover on a “staff available” basis.
 

Medical procedures conducted inside the practice’s facilities

When reporting procedure counts and gross charges for practice activities, it is necessary to identify whether the activity occurred inside or outside the practice’s facilities. This inside/outside distinction enables the proper assignment of operating costs to develop cost per unit output statistics. The Centers for Medicare and Medicaid Services (CMS) “place of service” codes are used to make this inside/outside distinction. There is one “place of service” code, the “office” code (11), which indicates activity inside the practice’s facilities. All other place of service codes (12-81) are for activities occurring outside the practice’s facilities. Examples of “outside” locations are the patient’s home, inpatient or outpatient hospital, psychiatric or rehabilitation facility, emergency room, freestanding ambulatory surgery center, birthing center, skilled nursing or custodial care facility, hospice, ambulance, independent laboratory or radiology and imaging center, ambulatory emergency
center, etc.
Include:

• Procedures performed by all practice physicians, advanced practice providers, and other healthcare professionals such as nurses, medical assistants, and technicians; and

• Purchased procedures from external providers and facilities on behalf of the practice’s fee-for- service patients for which revenue is reported as a subset of “Total net fee-for-service collections/ revenue” and for which costs are reported as a subset of “Clinical laboratory,” “Radiology and imaging,” and “Other ancillary services.”

Do not Include:

• Purchased procedures from external providers and facilities on behalf of the practice’s capitation patients for which costs are reported as “Purchased services for capitation patients.”

**If the observed medical practice uses CMS Procedural Coding System (CMS PCS) codes, please use your best judgment to assign the G, H, M, Q, S, and T code counts and gross charges to the appropriate categories.

The five digit numbers in the following lists are the Current Procedural Terminology (CPT) codes published in Current Procedural Terminology CPT 2020 (American Medical Association, 2020).
 

Medical procedures conducted inside the practice’s facilities

Include:

Evaluation and Management Services (given an appropriate location code)

• 99201-99215, office or other outpatient services;

• 99241-99245, office or other outpatient consultations;

• 99354-99360, prolonged and standby services;

• 93792-93793, 99366-99368, 99441-99449, case management services;

• 99374-99375, 99377-99380, care plan oversight services;

• 99381-99387, 99391-99397, 99401-99404, 99406-99409, 99411-99412, 96160, 99429, preventive medicine services;

• 99450, 99455-99456, special evaluation and management services; and

• 99460-99465, newborn care. Radiology Services (given an appropriate location code)

• 77261-77799, radiation oncology; and

• 79005-79999, therapeutic nuclear medicine. Medicine Services (given an appropriate location code)

• 90281-99091; and

• 99170-99199, other services/procedures.

Do not Include:

• 10021-69990, surgery procedures. These procedures are reported as “Surgery and anesthesia procedures”;

• 70010-76499, diagnostic radiology. These procedures are reported as “Diagnostic radiology and imaging procedures”;

• 76506-76999, diagnostic ultrasound. Report in “Diagnostic radiology and imaging procedures”;

• 78012-78999, diagnostic nuclear medicine. Report in “Diagnostic radiology and imaging procedures”; or

• 80047-89398, clinical laboratory and pathology. These procedures are reported as “Clinical laboratory and pathology procedures.”
   

Medical procedures conducted outside the practice’s facilities

Include:
The same items listed under “Medical procedures conducted inside the practice’s facilities,” given an appropriate location code:

• 99217-99226, hospital observation services;

• 99221-99223, 99231-99236, 99238-99239, hospital inpatient and observation services;

• 99251-99255, inpatient consultations;

• 99281-99285, 99288, emergency services;

• 99291-99292, critical care services;

• 99466-99467, 99471-99472, 99475-99476, pediatric critical care services;

• 99468-99469, 99477-99480, neonatal critical and intensive care services;

• 99304-99310, 99315-99316, 99318, nursing facility services;

• 99324-99328, 99334-99337, domiciliary, rest home, or custodial care services;

• 99354-99360, prolonged and standby services;

• 99341-99345, 99347-99350, home services;

• 99460-99465, newborn care; and

• 99500-99602, home health services.

Surgery and anesthesia procedures conducted inside the practice’s facilities

Include:

• 00100-01999, anesthesia procedures;

• 10021-36410, 36420-69990, surgery procedures;

• 99100-99140, anesthesia procedures; and

• Surgery and anesthesia procedures performed in the practice’s own ambulatory surgery unit.

Do not Include:

• 36415 and 36416, venous and capillary blood collection.
   

Surgery and anesthesia procedures conducted outside the practice’s facilities

Include:

• Surgery and anesthesia procedures performed in an inpatient hospital or a freestanding ambulatory surgery center.

• 00100-01999, anesthesia procedures;

• 10021-36410, 36420-69990, surgery procedures;

• 99100-99140, anesthesia procedures; and

Do not Include:

• 36415 and 36416, venous and capillary blood collection.
   

Clinical laboratory and pathology procedures

Include:

• 36415 and 36416, venous and capillary blood collection;

• 80047-89398, a panel of tests represented by a single CPT code is considered to be one procedure;

• HCPCS P codes;

• All clinical laboratory and pathology procedures conducted by laboratories outside of the practice’s facilities as long as the practice pays the outside laboratory directly for the procedures and the procedures are only for the practice’s fee-for-service patients. The cost for these purchased laboratory services should be reported as a subset of “Clinical laboratory;” and

• All procedures done either at the practice (where the practice bills at a global rate for both the technical and professional components) or procedures done at an outside facility (where the practice bills at a professional rate only).

Do not Include:

• Purchased laboratory services from external providers and facilities on behalf of the practice’s capitation patients for which costs are reported as “Purchased services for capitation patients.”
   

Diagnostic radiology and imaging procedures

Include:

• 70010-76499, diagnostic radiology;

• 76506-76999, diagnostic ultrasound;

• 78012-78999, diagnostic nuclear medicine;

• All diagnostic radiology and imaging procedures conducted by laboratories outside of the practice’s facilities as long as the practice pays the outside laboratory directly for the procedures and the procedures are only for the practice’s fee-for-service patients; and

• All procedures done either at the practice (where the practice bills at a global rate for both the technical and professional components) or procedures done at an outside facility (where the practice bills at a professional rate only).

Do not Include:

• 77261-77799, radiation oncology;

• 79005-79999, therapeutic nuclear medicine. Radiation oncology and therapeutic nuclear medicine activity is included in “Medical procedures,” depending on location code; or

• Purchased radiology services from external providers and facilities on behalf of the practice’s capitation patients for which costs are reported as “Purchased services for capitation patients.”
   

Total procedures and procedural gross charges

Add “Medical procedures conducted inside the practice's facility,” “Medical procedures conducted outside the practice's facility,” “Surgery and anesthesia procedures conducted inside the practice's facility,” “Surgery and anesthesia procedures conducted outside the practice's facility,” “Clinical laboratory and pathology procedures” and “Diagnostic radiology and imaging procedures” for both Total procedures and Procedural gross charges.
 

Nonprocedural gross charges (include chemotherapy drug charges)

Other charges not reported in “Medical procedures conducted inside the practice’s facilities” through “Diagnostic radiology and imaging procedures” in the Gross Charges column.
Include:

• Facility fee charges for the operation of an ambulatory surgery unit;

• Facility fee charges in a hospital-affiliated practice that utilizes a split billing system where both facility fees and professional charges are billed;

• Charges for drugs and medications, administered inside the practice’s facilities, such as chemotherapy drugs; and

• Charges for HCPCS A, J, R, and V codes.

Do not Include:

• Charges for the sale of medical goods and services. Such charges are not reported anywhere on this survey.
   

Total gross charges

Add “Total procedures and procedural gross charges” and “Nonprocedural gross charges.”
 

How many Resource Based Relative Value Scale (RBRVS) total and physician work relative value units (RVUs) units did your practice produce?

If you are an MGMA member and would like assistance in calculating your RVUs, please visit http://data.mgma.com/DataTools/rdPage.aspx to use the RVU calculator.

Report the relative value units (RVUs), as measured by the Resource Based Relative Value Scale (RBRVS), not weighted by a conversion factor, attributed to all professional services. An RVU is a nonmonetary standard unit of measure that indicates the value of services provided by physicians, advanced practice providers, and other healthcare professionals. The RVU system is explained
in detail in the November 15, 2019 Federal Register, pages 62568-63563. Addendum D: Relative Value Units (RVUs) and Related Information presents a table of RVUs by CPT code. Your billing system vendor should be able to load these RVUs into your system if you are not yet using RVUs for management analysis. When answering this question, note the following:

• The RVUs published in the November 15, 2019 Federal Register, effective for calendar year 2020, should be used; and

• The total RVUs for a given procedure consist of three components:

  • Physician work RVUs;

  • Practice expense (PE) RVUs; and

  • Malpractice RVUs.

Thus, total RVUs = physician work RVUs + practice expense RVUs + malpractice RVUs.

• For 2020, there were two different types of practice expense RVUs:

  • Fully implemented nonfacility practice expense RVUs; and

  • Fully implemented facility practice expense RVUs.

• “Nonfacility” refers to RVUs associated with a medical practice that is not affiliated with a hospital and does not utilize a split billing system that itemizes facility (hospital) charges and professional charges. “Nonfacility” also applies to services performed in settings other than a hospital, skilled nursing facility, or ambulatory surgery center. You should report total RVUs that are a function of “nonfacility” practice expense RVUs.

• “Facility” refers to RVUs associated with a hospital affiliated medical practice that utilizes a split billing fee schedule where facility (hospital) charges and professional charges are billed separately. “Facility” also refers to services performed in a hospital, skilled nursing facility, or ambulatory surgery center. If you are a hospital affiliated medical practice that utilizes a split billing fee schedule, you should report your total RVUs as if you were a medical practice not affiliated with a hospital.

• To summarize, there are two different types of total RVUs:

  • Fully implemented nonfacility total RVUs; and

  • Fully implemented facility total RVUs.

• The Federal Register Addendum D presents six columns of RVU data. The column labeled “Physician work RVUs” is what you should report as work RVUs. Any adjustments to RVU values through periodic adjustments and updates made by CMS should be included.
   

⭐*Work RVUs

Include:

• RVUs for the “physician work RVUs” only; including any adjustments made as a result of modifier usage;

• Work RVUs for all professional medical and surgical services performed by providers;

• Work RVUs for the professional component of laboratory, radiology, medical diagnostic, and surgical procedures;

• Work RVUs for all procedures performed by the medical practice. For procedures with either no listed CPT code or with an RVU value of zero, RVUs can be estimated by dividing the total gross charges for the unlisted or unvalued procedures by the practice’s known average charge per RVU for all procedures that are listed and valued;

• Work RVUs for procedures for both fee-for-service and capitation patients;

• Work RVUs for all payers, not just Medicare;

• Work RVUs for purchased procedures from external providers on behalf of the practice’s fee-for- service patients;

• Anesthesia practices should provide the physician work component of the RVU for flat fee procedures only such as lines, blocks, critical care visits, intubations, and post-operative management care; and

• All RVUs associated with professional charges, including both medically necessary and cosmetic RVUs.

Do not Include:

• RVUs for “malpractice RVUs”;

• RVUs for other scales, such as McGraw-Hill, California;

• RVUs for purchased procedures from external providers on behalf of the practice’s capitation patients;

• RVUs that have been weighted by a conversion factor. Do not weigh the RVUs by a conversion factor; or

• RVUs where the Geographic Practice Cost Index (GPCI) equals any value other than one. The GPCI must be set to 1.000 (neutral).
   

⭐*Total RVUs

Include:

• RVUs for the “physician work RVUs,” “practice expense,” and “malpractice RVUs,” including any adjustments made as a result of modifier usage;

• RVUs for all professional medical and surgical services performed by physicians, advanced practice providers, and other physician extenders such as nurses and medical assistants;

• RVUs for the professional component of laboratory, radiology, medical diagnostic, and surgical procedures;

• For procedures with either no listed CPT code or with an RVU value of zero, RVUs can be estimated by dividing the total gross charges for the unlisted or unvalued procedures by the practice’s known average charge per RVU for all procedures that are listed and valued;

• RVUs for procedures for both fee-for-service and capitation patients; and

• RVUs for all payers, not just Medicare.

Do not Include:

• RVUs for other scales such as McGraw-Hill, California;

• The technical component (TC) associated with any medical diagnostic, laboratory, radiology, or surgical procedure. If your practice cannot break this out, report RVUs and select the appropriate response to the question regarding technical component. If you can report total RVUs without technical component, answer 0% for the technical component question; or

• RVUs where the Geographic Practice Cost Index (GPCI) equals any value other than one. The GPCI must be set to 1.000 (neutral).

Total ASA units

ANESTHESIOLOGY SPECIALTIES ONLY

For anesthesiology practices, provide the American Society of Anesthesiologists (ASA) units. The ASA units for a given procedure consist of three components:

• Base unit;

• Time in 15-minute increments; and

• Risk factors.

Please note:

• Adjustments should be made if the provider supervises a CRNA that is not employed by the reporting practice; and

• Do not duplicate units for split bills. Instead, report units on a per case basis.
   

*Number of individual patients

The total number of individual patients who received services from the practice during the 12-month reporting period.

Include:

• Fee-for-service and capitation patients. A patient is simply a person who received at least one service from the practice during the 12-month reporting period, regardless of the number of encounters or procedures received by that person. If a person was a patient during 2019, but did not receive any services at all during 2020, that person would not be counted as a patient for 2020. A patient is not the same as a covered life. The number of capitated patients, for example, could be less than the number of capitated covered lives if a subset of the covered lives did not utilize any services during the 12-month reporting period.
   

Number of patient encounters

A documented interaction, regardless of setting (including tele-visits and e-visits), between a patient and healthcare provider(s) for the purpose of providing medical services, assessing illness or injury, and determining the patient's health status. If a patient sees two different providers on the same day for one diagnosis, it is one encounter. If a patient sees two different providers on the same day for two unrelated issues, then it is considered two encounters. Encounters are procedures from the evaluation and management chapter (CPT codes 99201-99499) or the medicine chapter (CPT codes 90281-99607) of the Physicians’ Current Procedural Terminology, Fourth Edition, copyrighted by the American Medical Association (AMA).
Include:

• Pre- and post-operative visits and other visits associated with a global charge;

• Visits that resulted in a coded procedure;

• The total number of procedures or reads for diagnostic radiologists and pathologists, regardless of place of service;

• For obstetrics care, where a single CPT-4 code is used for a global service, count each as a separate ambulatory encounter (e.g., each prenatal visit and postnatal visit is one encounter). Count the delivery as a single encounter; and

• Encounters that include procedures from the surgery chapter (CPT codes 10021-69990) or anesthesia chapter (CPT codes 00100-01999).

Do not Include:

• Encounters with direct provider to patient interaction for the specialties of pathology or diagnostic radiology (see #3 above under "Include”);

• Visits where there is not an identifiable contact between a patient and a physician or advanced practice provider (i.e., patient comes into the practice solely for an injection, vein puncture, EKGs, EEGs, etc. administered by an RN or technician);

• Administration of chemotherapy drugs; or

• Administration of immunizations.
   

Practice panel size for the past 18 months

CARDIOLOGY AND PRIMARY CARE PRACTICES ONLY

Answer the panel size or ‘set of patients cared for by a physician’ as the number of individual unique patients that have been seen by any provider within the practice over the past 18 months. To determine the panel size per physician, use the following methodologies:

• If a patient has only seen one physician in the practice, assign the patient to that physician.

• If a patient has seen more than one physician in the practice, assign the patient to the physician seen most frequently.

• If a patient has seen more than one physician in the practice the same number of times, assign the patient to the physician who did the patient's last physical.

• If a patient has not had a physical, assign him/her to the physician seen most recently.
   

*Surgical anesthesia

ANESTHESIOLOGY PRACTICES ONLY

Include:

• Any case with base and time units where anesthesia services such as general, regional or MAC are provided, regardless of whether or not there were multiple providers on the case. Generally these are the “0” anesthesia codes or services which cross over to these codes. Obstetrical cases, critical care, chronic and acute pain services, as well as flat fee procedures are each listed as a separate category for which you will give separate counts.

• List base units and minutes for surgical anesthesia cases only.

  • For base units and time minutes, list one set of base units and time minutes per case only. Do not double-count medically directed cases. The best way for most practices to do this is to list physician base units and physician minutes only.

  • Academic practices should beware not to double count resident units and should only count units for the supervising attending.

  • If you have a significant number of cases which involve unsupervised CRNAs (QZ modifier), the base units and minutes for these cases should be added.

For the “Charge per ASA unit,” indicate the monetary fee that is applied to an American Society of Anesthesiologists (ASA) unit. The ASA units for a given procedure consist of three components:

• Base unit;

• Time in 15-minute increments; including time converted from 10-minute or 12-minute time units to 15-minute increments. The divisor to convert a pool of 10-minute time units to 15-minute units is 0.6667, and the divisor to convert a pool of 12-minute time units to 15-minute units is 0.80. For example, a 4-hour case will generate 24 10-minute time units, which is the equivalent of 16 15-minute time units (24 / 0.6667 = 16) or 20 12-minute time units, which is still the equivalent of 16 15-minute time units (20 / 0.80 = 60); and

• Risk factors, which include the full value, at the practice’s undiscounted rates, of all services provided to fee-for-service, discounted fee-for-service, and non-capitated patients for all payers. If you charge time units based upon something other than 15 minute units, use your best efforts to convert your charge per unit to an equivalent amount that you would charge if you were billing based upon 15 minute time units.
   

Labor epidurals (CPT codes 59409, 01960, 01967)

ANESTHESIOLOGY PRACTICES ONLY

Include:

• Labor epidurals (59409, 01960 or 01967). If a labor epidural is started and then a C-section is performed, count as one of each.
   

C-Sections (CPT codes 59514, 01961, 01968)

ANESTHESIOLOGY PRACTICES ONLY

Include:

• C-sections (59514, 01961 or 01968). If a labor epidural is started and then a C-section is performed, count as one of each.
   

Epidurals (CPT codes 62324, 62326)

ANESTHESIOLOGY PRACTICES ONLY

Include:

• The epidural (62324, 62326) for the day that the procedure was performed and count each day of subsequent follow-up as one follow-up visit (01996). For example, if patient A has an epidural placed for post-op pain on Monday and you visit him/her on Tuesday, Wednesday, and Thursday, you would list one epidural and three days of follow-up visits.
   

Follow-up visits (CPT codes 01996, 99231-99233)

ANESTHESIOLOGY PRACTICES ONLY

Include:

• The epidural (62318, 62319) for the day that the procedure was performed and count each day of subsequent follow-up as one follow-up visit (01996). For example, if patient A has an epidural placed for post-op pain on Monday and you visit him/her on Tuesday, Wednesday, and Thursday, you would list one epidural and three days of follow-up visits.
   

Nerve blocks for post op pain (CPT codes 64400-64530)

ANESTHESIOLOGY PRACTICES ONLY

Include:

• Nerve blocks for post op pain (CPT codes 64400-64530).
   

Critical care services (CPT codes 99291, 99292)

ANESTHESIOLOGY PRACTICES ONLY

Include:

• Critical care services (CPT codes 99291, 99292).
   

Telehealth gross charges

Include

• The full value, at the practice’s undiscounted rates, of charges for all services provided to telehealth patients regardless of payer types (i.e. government and commercial) or type of virtual service (i.e. telehealth, virtual check-in, e-visits etc.).
   

Adjustments to telehealth gross charges

The difference between “Telehealth gross charges” and the amount expected to be paid by all payer types. This represents the value of telehealth and virtual services performed for which payment is not expected.
 

Adjusted telehealth charges

Subtract "Adjustments to telehealth gross charges” from "Telehealth gross charges.”
 

Overall telehealth revenue

Include:

• All revenue directly attributed to telehealth services. This includes revenue received by all payer types (i.e. government or commercial) for any type of virtual service (i.e. telehealth visit, virtual check-in, e-visits etc.).

Do not Include:

• Revenue from in-person visits.
   

Overall cost of telehealth-based technology

Enter the practice’s overall annual cost of telehealth technology
Include:

• Equipment cost including, but not limited to, technology support, subscription fees, staffing training on software or program, video/audio platform, software platform and hardware devices.

Do not Include:

• Staff compensation and costs not related to staff training on telehealth software or programs.
   

Number of telehealth encounters

The total number of telehealth encounters (including telehealth visits, virtual check-ins and e-visits) between a patient and a healthcare provider who is vested with the primary responsibility of diagnosing, evaluating, and/or treating the patient's condition, where the provider exercises clinical judgment that may or may not be billable.