Anesthesiology Assistants
Federal regulations at 42 CFR § 410.69(b) defines an anesthesiology assistant as a person who:
(1) Works under the direction of an anesthesiologist;
(2) Is in compliance with all applicable requirements of state law, including any licensure requirements the state imposes on non-physician anesthetists; and (3) Is a graduate of a medical school-based anesthesiologist's assistant educational program that:
(A) Is accredited by the Committee on Allied Health Education and Accreditation; and
(B) Includes approximately 2 years of specialized basic science and clinical education in anesthesia at a level that builds on a premedical undergraduate science background.
With respect to education and training, Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, section 140.1 further describes an anesthesiology assistant as a person who has successfully completed a 6-year program for anesthesiology assistants, of which 2 years consists of specialized academic and clinical training in anesthesia.
Inter-Jurisdictional Reassignments
A. General Policy
If a physician/NPP (reassignor) is reassigning his or her benefits to an entity (reassignee) located in another contractor jurisdiction – a practice that is permissible - the following principles apply:
1. The reassignor must be properly licensed or otherwise authorized to perform services in the state in which he or she has his or her practice location. The practice location can be an office or even the individual’s home (for example, a physician interprets test results in his home for an independent diagnostic testing facility).
2. The reassignor need not – pursuant to the reassignment - enroll in the reassignee’s contractor jurisdiction nor be licensed/authorized to practice in the reassignee’s state. If the reassignor will be performing services within the reassignee’s state, the reassignor must enroll with the Medicare contractor for – and be licensed/authorized to practice in – that state.
3. The reassignee must enroll in the contractor jurisdictions in which (1) it has its own practice location(s), and (2) the reassignor has his or her practice location(s). In Case (2), the reassignee:
• Shall identify the reassignor’s practice location as its practice location on its Form CMS-855B
• In Section 4A of its Form CMS-855B shall select the practice location type as “Other health care facility” and specify “Telemedicine location.”
• Need not be licensed/authorized to perform services in the reassignor’s state.
To illustrate, suppose Dr. Smith is located in Contractor Jurisdiction X and is reassigning his benefits to Jones Medical Group in Contractor Jurisdiction Y. Jones must enroll with X and with Y. Jones need not be licensed/authorized to perform services in Dr. Smith’s state. However, in Section 4 of the Form CMS- 855B it submits to X, Jones must list Dr. Smith’s location as its practice location.
B. Applicability
The term "reassignee," as used in section 15.5.20.1(A), includes any provider or supplier that is permitted to bill and receive payment under a reassignment, in accordance with existing Medicare policy.
Timeliness and Accuracy Standards
Sections 15.6.1 through 15.6.3 of this chapter address the timeliness and accuracy standards applicable to the processing of Form CMS-855 applications. Even though the provisions of 42 CFR §405.818 contain processing timeframes that differ than those in sections 15.6.1 through 15.6.3, the contractor shall adhere to the standards specified in sections 15.6.1 through 15.6.3.
The processing of an application generally includes, but is not limited to, the following activities:
• Receipt of the application in the contractor’s mailroom and forwarding it to the appropriate office for review.
• Prescreening the application.
• Creating a logging and tracking (L & T) record and an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS).
• Ensuring that the information on the application is verified.
• Requesting and receiving clarifying information.
• Site visit (if necessary).
• Formal notification to the SA and/or RO of the contractor’s approval, denial or recommendation for approval of the application.
Federal regulations at 42 CFR § 410.69(b) defines an anesthesiology assistant as a person who:
(1) Works under the direction of an anesthesiologist;
(2) Is in compliance with all applicable requirements of state law, including any licensure requirements the state imposes on non-physician anesthetists; and (3) Is a graduate of a medical school-based anesthesiologist's assistant educational program that:
(A) Is accredited by the Committee on Allied Health Education and Accreditation; and
(B) Includes approximately 2 years of specialized basic science and clinical education in anesthesia at a level that builds on a premedical undergraduate science background.
With respect to education and training, Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, section 140.1 further describes an anesthesiology assistant as a person who has successfully completed a 6-year program for anesthesiology assistants, of which 2 years consists of specialized academic and clinical training in anesthesia.
Inter-Jurisdictional Reassignments
A. General Policy
If a physician/NPP (reassignor) is reassigning his or her benefits to an entity (reassignee) located in another contractor jurisdiction – a practice that is permissible - the following principles apply:
1. The reassignor must be properly licensed or otherwise authorized to perform services in the state in which he or she has his or her practice location. The practice location can be an office or even the individual’s home (for example, a physician interprets test results in his home for an independent diagnostic testing facility).
2. The reassignor need not – pursuant to the reassignment - enroll in the reassignee’s contractor jurisdiction nor be licensed/authorized to practice in the reassignee’s state. If the reassignor will be performing services within the reassignee’s state, the reassignor must enroll with the Medicare contractor for – and be licensed/authorized to practice in – that state.
3. The reassignee must enroll in the contractor jurisdictions in which (1) it has its own practice location(s), and (2) the reassignor has his or her practice location(s). In Case (2), the reassignee:
• Shall identify the reassignor’s practice location as its practice location on its Form CMS-855B
• In Section 4A of its Form CMS-855B shall select the practice location type as “Other health care facility” and specify “Telemedicine location.”
• Need not be licensed/authorized to perform services in the reassignor’s state.
To illustrate, suppose Dr. Smith is located in Contractor Jurisdiction X and is reassigning his benefits to Jones Medical Group in Contractor Jurisdiction Y. Jones must enroll with X and with Y. Jones need not be licensed/authorized to perform services in Dr. Smith’s state. However, in Section 4 of the Form CMS- 855B it submits to X, Jones must list Dr. Smith’s location as its practice location.
B. Applicability
The term "reassignee," as used in section 15.5.20.1(A), includes any provider or supplier that is permitted to bill and receive payment under a reassignment, in accordance with existing Medicare policy.
Timeliness and Accuracy Standards
Sections 15.6.1 through 15.6.3 of this chapter address the timeliness and accuracy standards applicable to the processing of Form CMS-855 applications. Even though the provisions of 42 CFR §405.818 contain processing timeframes that differ than those in sections 15.6.1 through 15.6.3, the contractor shall adhere to the standards specified in sections 15.6.1 through 15.6.3.
The processing of an application generally includes, but is not limited to, the following activities:
• Receipt of the application in the contractor’s mailroom and forwarding it to the appropriate office for review.
• Prescreening the application.
• Creating a logging and tracking (L & T) record and an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS).
• Ensuring that the information on the application is verified.
• Requesting and receiving clarifying information.
• Site visit (if necessary).
• Formal notification to the SA and/or RO of the contractor’s approval, denial or recommendation for approval of the application.
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