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Clinical Issues in Intensive Outpatient Treatment for Substance Use Disorders

An overview on Intensive Outpatient (IOP) treatment, this article focuses on the benefits of an IOP program that balances individualized care with other community social services to create recovery networks for patients.

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Using Motivational Interviewing in Substance Use Disorder Treatment

This article elaborates on how MI allows clients to better understand their own values and goals in order to promote lasting positive outcomes through internal motivational change.

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Crisis Services: Meeting Needs, Saving Lives

With mental illness being the nation’s most prevalent disability, this toolkit seeks to establish national guidelines and transform the infrastructure of the US’ inconsistent and lacking crisis care system.

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Treating Substance Use Disorder in Older Adults

Substance misuse in older adults is often overlooked. This publication helps providers identify and better treat this population using methods that are tailored to their age-related needs.

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Improving Cultural Competence

A guide for healthcare workers that emphasizes the importance of cultural competence and the consideration of racial and ethnic factors to provide better experiences for both clients and providers.

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Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery

An overview for working with clients struggling with SUD in addition to how to best create organizational change so that providers can achieve high-quality service.

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Highlights of Federal Legislation Affecting Treatment Provider Funding

A collection of links related to substance use disorder specific programs as a result of the $1.9 trillion American Rescue Plan and previous legislation

It may appear simple but the annual release of the conversion factors by CMS can have a substantial impact on your revenue cycle especially if you are bidding on new business. The differences of locality can be substantial and should be researched prior to making any revenue forecasts.


CMS issues a conversion factor table annually that outlines the rate CMS will reimburse for each anesthesia unit billed. The formula is as follows:

· (Base Units + Time Units) * Conversion Factor = Anesthesia Payment Amount.

The rate is an attempt by CMS to address the actual cost of care in that specific locality.


To assesses the impact on your practice or a new business opportunity it is important to review the locality table as updated each year. The table can be found at: under Important Links - Billing/Payment. Carefully review the locality for the business you are considering.

As an example, the conversion factor for Florida is $21.93 but the rate increases to $23.78 for Miami (an increase of $1.85 or 8.4%). What can this mean to a practice? If a practice is fully in-network with a typical payer mix of 50% government payers and 50% commercial payers and annual unit volume of 100,000 the difference in reimbursement will be more than $200k annually.

What do you need to do?

There are several things you need to do:

· Ensure you know the CMS determined locality for the facility location (just saying it is in the Miami area is not sufficient).

· Understand the volume of units produced in that location (units will vary greatly from case volume).

· Be careful of multi-locational operations as each will need to be assessed individually.

· Do not assume that simply being an expensive area to live will have higher reimbursement. Florida outside of Miami pays $21.93, Hawaii only pays $21.79.


If you have further questions about your anesthesia business opportunities, please reach out to Value-Based RCM. We are always available to assess the opportunity with you.

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