1. The policy would have reduced payments for evaluation and management services provided the same day as a procedure or wellness exam from 50 percent to 25 percent. Anthem planned to implement the policy beginning March 1 to eliminate duplicate payments thought to be occurring.
2. Anthem’s Executive Vice President and Chief Clinical Officer Craig Samitt, MD, announced the policy reversal Feb. 23 in a letter to the American Medical Association.
3. “While Anthem is confident that duplication of payment for fixed/indirect practice expenses exists when physicians bill an E/M 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,” Dr. Samitt stated in the letter.
4. Anthem’s decision came after a coordinated effort by several organizations, including the California Medical Association, AMA and American Association of Dermatologists, to maintain the non-reduced rate.
More articles on coding, billing and collections:
Ohio auditor: Medicaid providers only repaid fraction of $19.7M owed to state — 4 insights
Maximize your 2018 reimbursements: Know your health plans, know your market, and stay on top of trends
Waystar CEO has plans to expand in Kentucky, considers IPO: 4 insights
