Recent news released by The Colorado Medical Society shares the response from Anthem regarding the reduction of payment for services that are provided on the same day. Read below for more information on the correspondence between CMS and Anthem:
The Colorado Medical Society, American Medical Association and other state medical societies have been actively advocating against a plan by Anthem Blue Cross Blue Shield to reduce payment for significant, separately identifiable evaluation and management (E/M) services that are provided on the same day a procedure is performed or a wellness exam is conducted.
The company announced in December that it would reduce the size of its planned pay cut from 50 percent to 25 percent and move the implementation date to March 1, 2018. CMS sent a letter on Dec. 15, 2017, from CMS President M. Robert Yakely, MD, to Elizabeth Kraft, MD, medical director of Anthem BCBS in Colorado.
In her Jan. 29 response, Kraft defended the pay cut citing duplication of the fixed/indirect practice expense when performing a minor surgery and E/M service on the same day by the same provider. “To redress the duplicative payment, Anthem’s Policy reduces the office visit reimbursement by 25 percent and, thereby, reduces the double payment for fixed/indirect practice expenses.”
Yakely responded on Feb. 12 that there is no overlap of indirect practice expense and that “by providing two separate and distinct services during the same visit the physician can be more efficient, streamline care for the patient and facilitate a prompt diagnosis, potentially avoiding additional out-of-pocked expense for the patient” – particularly for those in rural areas or seeking certain types of specialty care that have long wait times for non-emergency appointments. He continued, backing up his point that codes are already adjusted by the Relative Value Scale Update Committee (RUC) and that further reductions are inappropriate.
CMS stands by its original request that Anthem retract the new modifier 25 policy without delay. Watch for more information as this issue develops.
News updates provided by Colorado Medical Society, February 19, 2018.