Those monitoring regulations effective January 1, 2010 related to CMS payment policy for teaching CRNAs involved in two (2) concurrent anesthesia cases with student nurse anesthetists were likely confused by a November 20, 2009 CMS MLN Matters article that appeared to contradict the new regulatory language and CMS Transmittal 1859. Specifically, although the federal register commentary, regulation text and CMS transmittal seemed clear that the new payment policy permits the teaching CRNA to bill full anesthesia time for each of the two cases (as opposed to face-to face time only) as long as the teaching CRNA devotes his or her time to the two concurrent anesthesia cases and is not involved in other services, the November 20, 2009 MLN Matters article advised that time should be billed based on the actual amount of time present with the student (i.e., face-to-face time). Importantly, CMS recognized the error in the November 20, 2009 article and revised the article on December 15, 2009 to make clear that face-to-face time is not required.
In summary, the teaching CRNA may bill for both full base and time (as opposed to face-to-face time only) in each of the two concurrent student cases as long as: (1) the teaching CRNA devotes his/her full time to the cases and is not involved in other services; and (2) the teaching CRNA must be present with each student nurse anesthetist during the pre and post anesthesia care.
Please also note that in the commentary to the final regulations, CMS commented that AANA standards of the Council on Accreditation of Nurse Anesthesia Programs with regard to supervision of students must be met. In particular, for periods of concurrency for two student nurse anesthetist cases, another qualified anesthesia provider (CRNA or anesthesiologist) must be available to fulfill the standards. For example, to be available for the student to summon for clinical assistance should it be required.