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Anesthesia Concurrency & Medical Direction Auditor

When an anesthesiologist's concurrent room overlap exceeds the 1:4 statutory limit or misses one of the 7 TEFRA conditions, commercial payers recoup 100% of medical direction fees. Audit your OR crossover logs, determine exact modifier requirements (QK, QY, QX, QZ, AD), and eliminate retrospective audit clawbacks.

42 CFR § 415.110 & TEFRA 7 Statutory Compliance Engine

Anesthesia Concurrency & Medical Direction Auditor

Audit your operating room concurrency logs and CRNA supervision ratios. Model compliance under the 1:4 statutory limit, verify the 7 TEFRA conditions, simulate revenue under Modifiers QK, QY, QX, QZ, and AD, and calculate financial clawback exposure before commercial payers initiate post-payment audits.

1. Concurrency Ratio & Case Setup

Concurrent Rooms Directed by 1 MD3 Rooms (1:3)
1:1 (QY)1:2 (QK)1:4 (QK Limit)1:5+ (Broken AD)
Time Units (15m): 6Total Units: 12Full Case Allowed: $540

2. Audit Verdict & Modifier Directives

Low Audit Risk
Adjudication Status
Compliant 1:3 Medical Direction (Modifier QK & QX)
Anesthesiologist is directing 3 concurrent cases (within statutory 1:4 TEFRA limit) with all 7 clinical documentation conditions verified. Payment is split 50% to MD and 50% to CRNA.
Anesthesiologist (MD) LineModifier QK (Medical direction 2-4 cases)$270 Allowable
CRNA / AA LineModifier QX (Directed CRNA)$270 Allowable
Audit Recoupment Clawback Exposure:$0.00 (Fully Defensible)

Defensibility Compliance Checklist

  • Anesthesia records substantiate MD presence at induction/emergence in all overlapping rooms
  • OR timeline crossover logs show maximum of 4 concurrent running cases
  • All 7 TEFRA medical direction criteria explicitly met in clinical chart
  • Payment split 50% / 50%
ANSI X12 837P Loop 2400 SV1 Dual Lines
// MD Line:
SV1*HC:00840:QK:270.00:UN:12***1:2~
// CRNA Line:
SV1*HC:00840:QX:270.00:UN:12***1:2~
Zero-Cost Anesthesia Concurrency & TEFRA Audit

Protect Your Anesthesia Practice Against Medical Direction Audits

Commercial payers routinely subpoena hospital OR time logs and electronic records to demand recoupment of all Modifier QK payments. Submit 20 anesthesia cases to Aethera for a certified concurrency compliance audit at zero cost.

Next Step For Your Practice

Turn these Anesthesia Concurrency Auditor insights into a practice-specific review

Concerned about payer audits into overlapping surgical room start/stop times or CRNA supervision ratios? Aethera's certified anesthesia billing experts cross-audit every OR record against TEFRA criteria to secure compliant maximum reimbursement for both MDs and CRNAs. Let our senior AAPC-certified billing team audit 50 of your active claims or past denials — completely free. Results in 14 days after the BAA, complete intake and agreed success criteria.

Free 50-Claim Audit Pilot

Test our scrub rules and appeal workflow on 50 real claims. Zero commitment, no credit card required.

Instant A/R Gap Analysis

Enter your aging totals for an instant planning report. Uploaded files are processed locally; clinical intake is arranged separately.

Schedule 50-Claim PilotRun Free A/R Assessment
Scoped targets in writing Human review before submission HIPAA BAA Provided

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