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Maintenance of Certification in Anesthesiology (MOCA®)
American Board of Anesthesiology (ABA) re-certification program.
Medical Direction of CRNAs
Medical Direction of CRNAs means that an anesthesiologist "Medically Directs" Nurse Anesthetists or anesthesiologist assistants. Medical Direction of CRNAs is different from, "Medical Supervision of CRNAs".
Medical Direction of CRNAs/AAs
An anesthesiologist is in the medical direction mode when he is responsible for one to four CRNAs/AAs and meets Medicare's Seven Elements for Medical Direction.
Medical Supervision of CRNAs
When an anesthesiologist is medically directing more than four procedures concurrently or is performing services other than Medicare's six exceptions, the status of the case drops to a medically supervised mode.

It may also be used to bill for cases that start out as "medically directed" but in which the anesthesiologist becomes involved in other activities and is therefore unable to fulfill all seven requirements of medical direction.

The Medicare supervision modifier is AD.
Medically Directed AAs
Anesthesiologist Assistants (AA) must be Medically Directed. CRNAs may or may not be Medically Directed.
Medicare's Seven Elements for Medical Direction
  1. Perform a preanesthesia examination and evaluation;
  2. Prescribe the anesthesia plan;
  3. Personally participate in the most demanding procedures of the anesthesia plan;
  4. Ensure that all procedures are performed by a qualified anesthetists;
  5. Monitor the course of anesthesia at frequent intervals;
  6. Remain physically present and available for immediate diagnosis and treatment of emergencies;
  7. Provide indicated post-anesthesia care.
Medicare's Seven Elements of Medical Direction (Six exceptions)
There are six exceptions to the seven Elements of Medical Direction

The anesthesiologists may:
  1. Address an emergency of short duration in the immediate area;
  2. Administer an epidural or caudal anesthetic to ease labor pain;
  3. Periodically (rather than continuously) monitor an obstetrical patient;
  4. Receive patients entering the operating suite for the next surgery;
  5. Check or discharge patients in the recovery room;
  6. Facilitate and deal with scheduling matters.
Mirror Exclusivity
The anesthesia group given the exclusive contract can only work at that hospital and the hospital can only use that anesthesia group.
Mix of independent CRNAs and Anesthesiologists
Non-medically directed CRNAs working independently along side independent anesthesiologists. They may collaborate especially on difficult cases.
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