Subscribe by Email

Your email:

Follow PPMIS

Download the 5 Lessons to Anesthesia Billing PDF

5 Lessons to Anesthesia Billing

Download the Practice Readiness Roadmap

Practice Readiness Roadmap


Current Articles | RSS Feed RSS Feed

Successfully Implement New Anesthesia Billing Software


The decision to migrate to new medical billing software does not (and should not) come easily.  For many Practice Administrators and Billing Managers even imagining this change is so overwhelming the status quo is preferred even though it is costing time, money, and in extreme cases even increasing the groups liability risk.  If you are contemplating a software transition but are uncertain how to proceed we recommend following these general guidelines:

Request a Customized Demonstration

The first step is to request a demonstration of a platform you feel may be a good fit and provide as much feedback as possible into the typical workflow of your practice or billing service.  Qualified organizations should have no difficulties customizing the demonstration to reflect your anesthesia practices unique intricacies.  It can be very difficult to follow each step of an unfamiliar system so ask questions and if necessary request additional follow up demos to be sure you understand the platform.

Dig Deeper

If the initial demonstration addresses your needs it is typically beneficial to request additional demonstrations which dive deeper into the software so you can get a more accurate view of the full functionality.  Many organizations have sandbox environments they can provide to prospects to test drive the system before purchase which should be utilized whenever possible.  If this is an option, take full advantage of the opportunity and recreate a typical day’s workflow to flush out any previously unnoticeable issues.  The more in depth your understanding and familiarity with the new platform before a decision is made the better.

Visualize Change

Throughout the selection process it is vital to understand and expect change.  This will be true with any migration even if the workflows remain remarkably similar as there will always be differences from one system to another.  Hotkeys that have become second nature will need to be relearned, buttons may be in slightly different locations, and even actions which have fewer steps will feel slower as you adjust to the new system.  The key is to go into the migration expecting change and embracing the new workflows which will greatly increase adoption speeds.

Build Buy-In

Once you have a firm understanding and feel for the new system we recommend opening the evaluation to all relevant parties within the organization.  The Practice Administrator should also explain how it will take some time to adjust but it will address the organizations current pain points and be the best long term solution.  The more employees who see the new system, recognize the value, and are champions of change before implementation the better.  If a Practice Administrator forces change unexpectedly typically the new system is met with resistance by the office staff and the implementation and subsequent go live do not go as smoothly as it otherwise would have with widespread acceptance.


Finally after a decision is made fully commit and be engaged throughout the training process.  Training is not due to the lack of knowledge or ability of the client but is necessary walkthrough to ensure the software is being properly and efficiently utilized by the staff.  It is very common for groups to want to skip training or believe they will “figure it out” which is a recipe for disaster as it creates unnecessary frustration and friction between the group and the new software provider.

Efficient ways to collect patient balances


With healthcare costs increasing and companies pushing high deductible insurance plans, the percentage of patient responsible services for medical billing offices is increasing. This reality has placed a greater importance on patient collections. Let’s talk about simple processes that can increase the likelihood of collecting patient balances, as well as increase the productivity of your office staff.

The first and most simplistic process you can implement is to develop a contract between your group and the patient that allows you to store and charge a credit or debit card kept on file. These contracts are typically issued for one year and will most likely benefit patients with health or flex spending accounts. Once a balance has been deemed the responsibility of the patient a statement should be generated. This statement would remind the patient that an agreement has been made to charge these services to their card on file, if another method of payment is not provided in an allotted time frame.  This process is beneficial if your office has the luxury of checking eligibility for patients before a service is rendered. In most cases this eliminates specialties such as anesthesiology and radiology, in which services are scheduled prior to receipt of patient insurance information.

If patient collections are an unavoidable task for your office, you will need to decide if you have the means to appropriately staff this area. With limited resources it may be beneficial to look at automated processes such as electronic statement vendors and outside collection agencies. These solutions are a cost effective way to handle patient collections when limited staffing is a reality. If you have the resources to perform patient collections internally, you should consider the following questions:

  1. How often will I be generating patient statements?
  2. How many statements will be sent before my employees get involved?
  3. Will I be making phone calls and/or sending collection letters?
  4. When will I turn a balance over to an external collection agency?

Let’s take time and answer the first two questions regarding statements. It is a good practice to send statements every 28 days. When accounting for February this ensures a statement is generated at least once a month.  So, when should you get involved? A standard recommendation is after sending two statements, which should be modified if your state has a required number of patient contacts before escalating to an outside agency. This gives a patient close to 60 days before your staff gets involved in the collection process.

This takes us to our third question.  In most cases, taking the time to make one additional contact, whether it is a phone call and/or a collection letter, can pay dividends. A phone call or collection letter may prompt the patient to contact your office to make payment arrangements or provide additional insurance information.

This leads us to our final question. Should I get an external collection agency involved, and if so when? If a patient has not responded to a phone call or an additional letter it may be time to get an outside agency involved. It is an unfortunate fact that some patients will not be able to pay for their medical services. Hiring an agency that specializes in the collection of outstanding debt is a valuable asset in the medical billing industry.

jb blog pic resized 600

Regardless of the direction you take, it is important to adapt to the ever-changing medical billing industry. Trying new things may benefit your office in ways you never seemed possible.

Can the Cloud be safe for my medical billing data?


Isn't technology maddeningly delightful?  Confounding, yet compelling?  Being somewhat of an early-adopter, I welcome the challenges of new technology... however, if I'm smart, I'll keep my exploration in safe zones.  We barely trust the weather forecast, why should we trust the Cloud?  


In a nutshell, "cloud" here refers to using on line software.  (The unofficial origin of the "cloud" nomenclature is that people describing the Internet invariably chose the cloud shape.  Boxes were boxy, circles too round, and the rhombus - well, no one really remembers  that with "go to the chalkboard" confidence... so, the cloud shape took on a new symbolism. Sort of a promotion from "thought bubbles".) 

More officially:

nouncloud computingthe practice of using a network of remote servers hosted on the Internet to store, manage, and process data, rather than a local server or a personal computer.

Consider the Cloud as an environment in which business software systems can operate as opposed to the server room down the hall.  So, now that we know the definition, is cloud computing ready for prime time?  Should I trust the lifeblood of my business to this technology?  In short, the answer is Yes.  And, by yes, I mean the technology is ready and capable.  But, there's more to any business decision than capability... mainly, does the Cloud-based business software system I'm considering fit my business needs?  

  • May I exercise the system with my processes and procedures in a trial environment, e.g. a "sandbox"?  
  • Do the producers of the system have a trustworthy track record?  Do they understand my business specifically?
  • May I discuss the pros and cons of this system with my contemporaries who are the vendor's clients?

These are critically important questions to answer and each business needs to address them specifically and uniquely.  But, if they are answered to your satisfaction and the technology seems right for you, the challenge remains between this point and adoption; trust of the Cloud.  By the way, it's alright if getting to trust in this regard is a journey.  And, if this journey seems familiar, it is... vegetables, from our backyards to around the world; money, from mattress to banks; or accounting ledgers, from paper to databases; our children, from adoring us to independent citizens (but, I digress).

When it comes to trust, trust your questions, if you are responsible for a business unit and considering Cloud options, trust your concerns.  Cloud computing, or any technology, still requires your business acumen -- you should require answers to your important questions.  The data are yours, whether on your notepad, computer, down the hall or in the Cloud.

Since the Cloud has been around and developing for years, there are a plethora of resources available - lists of questions to ask a vendor you are considering for Cloud related services, reviews of other businesses that have used particular services, etc.  Make use of these to increase your comfort level and your successful use of the Cloud in your business.

I can't help you with your "weather forecast trust issues"... but, take a closer look at the Cloud as a candidate for your trust.

Anesthesia billing professionals gather at the PPMIS 2013 User Summit


Ever been to a PPMIS User Summit? If your answer is NO, the annual PPMIS User Summit is an event you don’t want to miss. Why? It’s a chance for our software and services clients and prospects to come and get to know other PPMIS clients, meet the faces of PPMIS, and learn about the software and services we offer during educational sessions, 1-on-1’s in the Support Center, networking breaks, social events and more!WebHome

The PPMIS 2013 User Summit was held August 25–28 at the Kansas City Marriott Country Club Plaza in Kansas City, Missouri. Originating from all over the country, this year’s conference included 100+ billing specialists, practice managers, coders, providers, PPMIS business partners and employees.

In addition to the thirteen PPMIS product sessions planned, we were happy to offer industry-focused sessions as well. Our special guest presenters from Auditing for Compliance and Education, Inc. (ACE) and Gateway EDI’s Dawn Duchek attracted many attendees this year.

ACE Sessions included four general sessions for CEUs:

  • Auditing Your Anesthesia Record, presented by Julie Drueppel, CPC
  • What to do when you’ve been overpaid? A walk through self-disclosure Devona Slater, CHC, CMCP
  • Getting Your EMR to Work for You, Donna Schlemmer, CPC
  • Ask the Auditors, ACE Consulting Panel

Preparing for ICD–10 Implementation — Steps You Should Take Now presented by Dawn Ducheck left attendees with an understanding how ICD–10 will benefit the healthcare industry, what components of your organization should be assessed for ICD–10 readiness, and a planning worksheet to determine your next steps for ICD–10 preparation.

This year, we were thrilled to have the support of eight (yes, 8!) business partners as exhibitors and sponsors. Gold Sponsors included Data Media Associates and Transworld Systems; Sponsors included DECA Financial Services and Trizetto’s Gateway EDI; and Exhibitors included Auditing for Compliance and Education, Inc., Medaxion, Shareable Ink and TKSoftware. A favorite this year, each exhibitor was given a session to demonstrate their products and/or services. This was in addition to the time attendees got in the exhibit hall during networking breaks. “This is what the User Summit is all about—how PPMIS works and how it works with its vendors!”—Scott Tinkham, Associated Anesthesiologists, P.C. The financial support from our exhibitors and sponsors allows PPMIS to plan off-site social events, offer tasty break refreshments, and provide exceptional giveaways and materials. The PPMIS User Summit is a great time for you to come meet our business partners and see how your company can benefit from their services.

While some may think it’s all work and no play, many networking opportunities take place after sessions end during our evening social events. Monday night, Gateway EDI sponsored transportation taking everyone to the Legends Kansas City. There was shopping, eating, and laughing by all! On Tuesday night, by popular request, our friends at Data Media Associates co-sponsored the Boulevard Brewery social event for 50 of the User Summit attendees. This event included a tour and another Kansas City favorite—Fiorella’s Jack Stack Barbecue!

Educational sessions, 1-on-1’s with PPMIS staff and business partners, networking breaks and social events—we have it all! If after reading this post you’re still not convinced the PPMIS User Summit is an event you don’t want to miss, give us a call. We’d be happy to persuade you some more!

Click here to view photos from the PPMIS 2013 User Summit.

Tags: ,

ACO - Friend or Foe to Anesthesiology?


ACO stands for Accountable Care Organization, but what does it really mean? According to a recent article in The Wall Street Journal (WSJ), The Model of the Future, “these entities propose to unite doctors and clinics or hospitals in groups that pool their resources with the goal of trimming spending while boosting the quality of care.”

On one hand the ACO seems like a friend

While in theory, the ACO seems like a helpful solution to healthcare reform. Many physicians remain skeptical--especially specialists. Many specialists including anesthesiology have concerns that the ACO model and its web of new regulations pose financial risks for providers. Although the intent of the formation of ACOs may be the unification of multiple healthcare providers around quality patient care delivery, the question of how the ACOs will truly function in the market remains unanswered. Pilot ACOs are up and running around the country to prove the concept.

In May 2011, the Center for Medicare and Medicaid Services (CMS) released a long-awaited rule that outlines the creation and operation of ACOs that will be eligible for potentially significant Medicare incentive payments in coming years. The Medicare ACO program, as defined by the Affordable Care Act (ACA), is slated to begin on January 1, 2012. For details, see our blog Medicare Proposes Accountable Care Organization ACO Guidelines.

But, on the other hand it could be a foe

What this new model means for anesthesia practices and the independent anesthesiologist remains to be seen. There were significant legal, financial, and risk concerns voiced during the comment period after the March 2011 issuance of the proposed rules. Many providers and medical groups saw significant financial risk in just starting up an ACO ($1.8MM estimate by CMS), in addition to the concerns over how they would capture the incentives for hitting the quality of care targets and measurements. What about the retrospective assignment of beneficiaries? Can hospitals clear the legal hurdles allowing them participation in the Shared Savings? Time is running out, and CMS has given no indication of the definitive answers to these questions.

What is the future for anesthesiologists?

It is now early 4th quarter, and we are still waiting on the final ACO rules. Anesthesiologists have always been leaders (not late adopters) in process improvements and care coordination. Must they take a back seat or will they prevail as leaders once again? So, questions remain about the role of anesthesiologists with the pioneer model of ACOs suiting primary care-only. A multitude of events must take place NOW leading up to January 1, 2012.

To continue with this saga and more, follow the PPMIS Blog.

Better yet, follow us on Twitter!

Follow PPMIS on Twitter, anesthesia billing and services

Bundled Payments of Joy for Anesthesia Services?


In about two months the federal government's healthcare reform bill will celebrate its first birthday. The Patient Protection and Affordability Care Act has created a ripple effect of healthcare reform provisions that are dramatically affecting both the patients and healthcare provider. Anesthesiology practices are trying to figure out how they will have to change the way they deliver care, and how they will get paid. Both issues are still not settled.

Bundled Payments

ACOs, healthcare reform, anesthesiologyMany reformers have believed that the solution to "fee for service" model that rewarded physicians for performing activities or services, would be to "bundle" payments around a particular health problem. This isn't new. Medicare proposed bundled payments for heart bypass surgery back in 1990. That demonstration project proved that bundled payments can work well. They were able to reduce costs, patients had better survival rates, and shorter hospital stays were part of the results. So, why hasn't there been a wider acceptance of these ideas, and adoption of the concept across a number of other specialties? There are a number of reasons, but the biggest one is---no one knows how to divide up the money in a fair and equitable manor. A second big issue is that there is no "standardized" patient, and hospitals are going to have those that blow their budgets with a peculiar health issue.

Enter the ACO

The Accountable Care Organization (ACO) is the latest rendition of the healthcare delivery team that will work cohesively to deliver great results at a lower cost. The rules around an ACO were announced in March 2011, and the final rule after a significant volume of questions were asked of CMS is due soon. The "Pioneer Model" of an ACO seems to have gained some traction for primary care providers, but many specialties and their associations (including anesthesiology) have voiced their concerns about the model.

From a story featured in Health Business Daily recently, a CMS official responded to feedback by health plans saying, "the Medicare Shared Savings Program (MSSP) needed some upgrades." He went on to state that the final rule would include the input and ideas from private health insurers. CMS administrator Dr. Donald Berwick has not given a specific date for release, but mentioned that release of a final rule to establish the ACO program for fee for service Medicare is "imminent." We will be covering this and other reimbursement issues in our upcoming issue of Vital Signs. 

Anesthesiology,ACO, and reimbursement      

Subscribe to Vital Signs, the PPMIS quarterly newsletter.

Stay up to date with the latest in healthcare reform, subscribe to the PPMIS Blog.

5 Nightmare Issues for Anesthesia Practice Managers


We are closing in quickly on the first anniversary of the passing of the Patient Protection & Affordability Care Act. Its effects on anesthesia practices are still unknown. Responding to tough economic times, new regulations, and an uncertain reimbursement future has left many practice managers and administrators wondering where they can legitimately cut more costs.

The fat is long gone, and their are no easy pickings left to cut-with more reimbursement cuts projected for 2012. If Medicare follows through with another 30 percent cut in physician payments, the ability to run a successful, innovative practice could become an elusive dream for many in practice today. Doing more with less is common, but how do practice managers continue to cut in light of increasing operating costs?

Juggling all of these high priority items every week does not add up to a restful night's sleep. In reality it may cause insomnia and a nightmare or two.

These are some of the sleep-disturbing issues that are top of mind:

  1. Selecting a vendor and installing an EMR.

  2. Determining eligibility for EMR meaningful use incentives.

  3. Handling rising operating costs.

  4. Finding and participating in an ACO (Accountable Care Organization).

  5. Adapting to shared financial risk for the practice.

With the final rules on ACOs and the models for shared risk still unclear, there needs to be greater clarity to "produce better quality at a lower cost" mantra. The rules and guidelines are not clear. CMS is still saying that ACOs will be operational on January 1, 2012. Does that still hold?

And the previously listed concerns do not even include the compliance deadlines of ANSI 5010 and installation of new ICD-10 codes. IT infrastructures will need to accommodate and test for these vital issues to maintain the cash flow of the practice.

PPMIS is offering a compliance checklist and FAQ sheet to help you meet these goals. Download the ANSI 5010 fact sheet today!

Stay tuned in to our blog and our e-newsletter called Vital Signs.  

EMR deadline issue

Can Healthcare Providers Keep the Pace?


With the threat of cost reductions and pay-for-performance initiatives looming, surveys indicate that many physicians are avoiding various tests and procedures. Is this wise? Aren’t physicians still liable for their patients care despite these financial incentives?

As the pressures mount, will physicians begin to undertreat patients by avoiding costly tests and procedures? Will the cost of malpractice insurance increase with more and more patients being undertreated and the threat of healthcare providers being sued?

Some medical professionals question whether patients should be more involved with the decision-making of their treatment. Would patients forego costly tests if they were well informed? Could physicians implement informed refusal? These are many of the questions behind controlling healthcare costs while maintaining quality patient care.

Like other disciplines, the anesthesia community is adopting quality of care standards to ensure patient safety. Putting patients to sleep ought to result in waking them up. Standards and checklists make this vital mission possible.

The Anesthesia Quality Institute provides anesthesiology with an unbiased, national and internal source of quality indicators and standards. The AQI was formed to lead the quality assurance initiative rather than having mandates for performance forces on its specialty by federal agencies, regulators, private payers, and surgical societies. Learn more by reading Why Is Quality of Care Vital in an Anesthesia Practice and 6 Key Measurements for AQI Reporting?

Will specialists be forced to join an Accountable Care Organization just to stay in practice? Physicians and hospitals are facing these challenges with impending payment threats and new payment models. Will healthcare providers sustain financial security in the days, weeks, and months ahead?

Medicare has already threatened to reduce payments in 2012 by 29.5%. While Center for Medicare and Medicaid Services (CMS) has proposed similar but smaller reductions in payment every year for the last nine years (as required by Medicare law), Congress has taken action each time to override the rate decrease. Fortunately, Medicare reimbursement rates for physicians have remained relatively static or actually increased in small increments from year to year.

Anesthesia practices beginning the 2012 budgeting process should not assume that "zero percent update" means that Medicare payment in 2012 will be equal to 2011 levels. Read more…Déjà vu: Medicare Payment Reductions Threaten Again.

Practice managers are also faced with meeting the federally mandated deadlines ANSI 5010, ICD-10 diagnostic codes, and EMR implementation. It seems the challenges just get bigger with each passing day. Bottom line healthcare providers are in business to make money. Can they maintain their practice while meeting the growing demands and obstacles?

Stay informed!

Subscribe to PPMIS blog and newsletter for anesthesia billing and servicesSubscribe to the PPMIS Blog for articles on current healthcare issues.

Subscribe to Vital Signs, our quarterly e-newsletter that addresses all this issues and more.



Anticipating ANSI 5010: CMS Ramps Up!


Many anesthesia practices are juggling resources and time lines getting ready for the HIPAA 5010 transaction set due to be implemented January 1, 2012. The Centers for Medicare and Medicaid Services (CMS), recently declared a 5010 Testing Week, and is also providing a series of "widgets" to help the industry prepare for the transition.

Almost right on the heels of this change, all medical practices will have to get ready for the changeover to the new ICD-10 diagnostic code set as well (2013). That change will move from the 13,000 codes being used today to a new set that will be over 140,000 separate codes for medical billing.

These are pretty compressed time frames, given the amount of work and testing needed to truly be ready. The federal government might be signaling that they won't be postponing their deadlines (which they did for ANSI 4010), and are lighting a fire under those entities that are behind in their testing. For a handy checklist for your practice, download our latest fact sheet. Failure to make the changes before the deadline exposes payers and providers to penalties.

What's a Practice Manager to do?

Is CMS also signaling that too many practices and the industry as a whole is not ready?

Will another delay be inevitable?

Are you willing to gamble?

That is a big gamble if your cash flow is interrupted, and your claim processing grinds to a halt. It would be a better move to keep on preparing, and keep a watchful eye on the CMS Web site (

Will your software vendor be ready?

For most providers who do not maintain their own IT systems, the work of writing the software code to support these changes is the responsibility of the software vendor.

PPMIS has been gearing up for ANSI 5010 since June 2010. We have included a list of questions to ask your software vendor in a previous blog post (

Recent queries by MGMA and other organizations have found that as many as 50% of payers are not testing yet, and most of 2011 was to be spent testing their systems, with the software upgrades having been complete. The days of a system being partially driven by paper and software are drawing quickly to a close. Both electronic billing and electronic funds transfer mean that providers will have to have reliable software, and will be seeing fewer and fewer paper checks in the days ahead.

For more on this issue and others that affect your practice and revenue cycle management, subscribe to our new Vital Signs e-newsletter below.

To learn more about the Connect billing software, request a product demonstration.

Request product demonstration of PPM Connect anesthesia billing software

6 Key Measurements for AQI Reporting


In 1999, the Institute of Medicine declared medical errors were among the leading causes of death in the United States. In contrast, anesthesiology was cited as an area in which there have been impressive gains in safety and quality (as in the aviation industry). Our recently posted blog, 9 Ways the Anesthesia Practice Is Like Aviation, provides a great comparison.

The Anesthesia Quality Institute (AQI) was created to provide the specialty with an unbiased, national and internal source of quality indicators and standards. The AQI was formed to lead the quality assurance initiative rather than having mandates for performance forced on its specialty by federal agencies, regulators, private payers, and surgical societies. PQRI and P4P are two of these incentives.

The primary responsibility of the AQI is developing the National Anesthesia Clinical Outcomes Registry (NACOR). As defined by the AQI, “NACOR is a data warehouse that will eventually capture the 40 million anesthetics (a very rough estimate) and millions of pain clinic procedures performed each year by anesthesiologists in the United States. The growth of NACOR requires close collaboration between the AQI, individual providers, and healthcare information technology vendors. The focus of participation in the AQI is the ongoing contribution of case-specific data to the NACOR. AQI’s program recognizes the anesthesia practices, hospitals, and information technology vendors that have succeeded in this effort.”


The main goal of AQI reporting is to aggregate the data from contributing anesthesia practices so that the practices can benchmark their care relative to peer groups. This data will be used for research into anesthesia risk factors, comparative effectiveness, and identification of best practices, which can then be used by ASA to develop quality measures, practice standards, and guidelines.

Anesthesia Quality Institute, anesthesia billingQuality management is vital in AQI reporting and ultimately provides the indicators for improving patient outcomes and business efficiency, and meeting regulatory requirements.

  1. Administrative data
  2. AIMS data
  3. Hospital EHR data
  4. Quality and outcome data – your group and other specialties
  5. Patient satisfaction information
  6. Anecdotes

Where can you pull the data you need? Your data is available from various sources:

  • The federal government (CMS – Medicare data and AHRQ – CAHPS data)
  • Private insurance companies
  • The Joint Commission
  • The ABA
  • Your IT vendors

Your IT vendor will play a major role is collecting your data. To participate as an AQI Preferred Vendor, the healthcare information technology company must have a product that actively meets AQI requirements for data transfer. The requirements in meeting the criteria include breadth and depth of data submitted, data formatted in accordance with the AQI-defined schema, data transfer to AQI in a safe and secure fashion, timeliness of data submission, and staying up to date with AQI changes.

AQI Preferred Vendor Status

Anesthesia Quality Institute preferred vendorPPMIS has met criteria deeming it a preferred vendor with the Anesthesia Quality Institute (AQI). This status is vital to PPMIS’ commitment to providing its clients with the tools for ensuring the best possible service to their patients. PPMIS clients can use the AQI reporting feature in our PPM: Connect and PPM Plus billing software for benchmarking the quality of care they provide.

With the Preferred Vendor status, PPMIS is posted on the AQI Preferred Vendor page at

PPMIS is a medical billing software and services company, specializing in anesthesia. Founded by anesthesiologist for the anesthesia community, PPMIS delivers a streamlined claim processing system.

Get paid faster because of fewer claim rejections and our comprehensive error checking and concurrency validations.

Contact PPMIS for a product demonstration.

PPM Connect product demo for anesthesia billing and services

All Posts