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  1. Practice structure considers and clarifies lines of authority, decision making, communication processes, information flow, and levels of authority that define how centralized or decentralized the practice functions.

  2. Staffing models require careful consideration of several issues, including the complexity of the case, experience of the provider, physical status of the patient, hospital regulations, surgeon expectations, and provider/resident/student nurse anesthetist teaching rules.

  3. Charges and payments for professional anesthesia services generally include base relative value units (accounting for anesthetic complexity), plus time units, plus additional unit modifiers multiplied by a dollar conversion factor.

  4. Successful negotiations with third-party payers and hospitals hinge on the clear articulation of needs by both parties and willingness of both parties to accept a reasonable offers as well as an accurate understanding of the value your group brings to the hospital or contracting organization.

  5. Billing systems must ensure that every service rendered is captured and that all monies contractually obligated for those services are collected.

  6. From a billing compliance perspective, if the service is not appropriately documented, then it did not happen. Compliance with various rules and regulations is both important and essential for the financial health of the practice. Further, the consequences of not knowing, or not following, these regulations can be substantial, both legally and financially.

  7. Monthly information that should be tracked for trend purposes includes total cases and units, cases and units per location, payer mix, charge lag, charges, contractual adjustments, cash collections, accounts receivable, net collection rate, days in accounts receivable, aged accounts receivable, total credit balances, and collection agency net collections.

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Practice management details are often delegated to nonphysician administrative professionals and their support staff, but it is important that all physicians have a global comprehension of basic practice management topics. Practice management, in its simplest form, focuses on the nonclinical pieces of a medical practice. There are entire textbooks just on practice management, so this chapter provides a brief overview of practice management for anesthesiologists. It broadly covers some global practice management areas that relate to all physicians, and when appropriate, it covers details and issues specific to anesthesia, such as billing and compliance, staffing models, and data analysis and reporting.

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To many physicians, worrying about the business side of their practice is something that they may have no interest in or even something they are embarrassed about because that is not why they decided to become a doctor. If, however, more money goes out than comes in, no business or physician will be able to continue to do what matters most to them. So, however confusing or distasteful the practice management side of the business may be, it is a necessary one.

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We hope this brief chapter complements the other chapters in this book and helps you become a physician who can face the challenges of the future of medicine by understanding basic business practice processes and relating them to the practice of anesthesiology.

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