Coverage of Preventive Services Under New Healthcare Law Causing Confusion

Although the new healthcare law covers colorectal cancer screening as a preventive service, patients may be billed if a physician finds and removes a polyp as a result of the screening procedure, according to a Kaiser Health News report.

The stipulation points to the fine line separating preventive services and treatment procedures and has caused some concern among professional societies, including the American Cancer Society and the American College of Gastroenterology.

Critics say cost-sharing brought on by health insurers may catch some patients by surprise, as published studies show colonoscopies can turn up polyps in at least 25 percent of men and 15 percent of women, according to the news report. ACG is among those who are lobbying to stop cost-sharing from being applied to patients of Medicare and some other private insurers.

Some insurers, including Aetna, Cigna and Humana, do not impose cost-sharing when a polyp is found during a routine colonoscopy.

Read the news report about the healthcare law and preventive services.

Read other coverage about preventive services:

- CMS Publishes Coding Guidance for Medicare-Covered Preventative Services

Modifier 33 "Most Noteworthy" Change in CMS' Outpatient Code Editor

Government: Older Americans Not Receiving Recommended Preventive Services

© Copyright ASC COMMUNICATIONS 2021. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.


Featured Webinars

Featured Whitepapers