Morgan Haefner | February 26, 2018
Anthem rescinded plans to cut reimbursement on certain same-day services following strong opposition from the American Medical Association, according to a letter Anthem sent to the AMA.
Here are three things to know about the change.
1. Under Anthem’s proposed policy, payments for evaluation and management codes under current procedural terminology modifier 25 would have been cut by 25 percent beginning March 1. The modifier concerned some separate services administered on the same day as a wellness exam or another procedure.
2. In a Feb. 23 letter to the AMA, Craig Samitt, MD, Anthem’s executive vice president and chief clinical officer, wrote, “While Anthem is confident that duplication of payment for fixed/indirect practice expenses exists when physicians bill an [evaluation/management] service appended with modifier 25 along with a minor surgical procedure (0 or 10 day global) performed on the same day, the company believes making a meaningful impact on rising health care costs requires a different dialogue and engagement between payers and providers.”
3. Anthem will formally notify providers about its decision within the next few days, the AMA said. Anthem’s pullback comes as the insurer is facing pushback from providers and lawmakers concerning other policies aimed at slashing expenses. These include the payer’s discretionary emergency room policy; its restrictive advanced imaging policy in hospital outpatient facilities; and its denial of general anesthesia or monitored anesthesia during most cataract surgeries.
Source: Beckers