Feb 26, 2018 | Uncategorized
nnAs many of you have been following this story, a new update has been released regarding the Anthem payment cut. Read the latest update below, including quotes from Anthem Executive Vice President and Chief Clinical Officer, Craig Samitt.nn
nnThe company had planned to reduce by 25 percent payments for evaluation and management services reported with modifier.nnAnthem has dropped its plan to reduce by 25 percent payments for certain evaluation and management codes.nnThe policy was to have gone into effect on March 1 across the company’s commercial health insurance businesses.nnThe insurer made the policy change in response to strong opposition from the American Medical Association and other physician groups, the AMA said on Friday, the same day it heard from Anthem.nnAnthem Executive Vice President and Chief Clinical Officer Craig Samitt told AMA Board Chair Jack Resneck, Jr., MD, that Anthem is rescinding plans to implement the policy to reduce payments by 25 percent for evaluation and management codes reported with a current procedural terminology modifier 25.nnAnthem had made the move to avoid duplicate payment for fixed or indirect practice expenses when physicians bill an evaluation and management service appended with modifier 25 along with a minor surgical procedure performed on the same day.nnHowever, Anthem said it believed that making a meaningful impact on rising healthcare costs required a different dialogue and engagement between payers and providers.nnAnthem plans to formally notify its contracted providers within the next few days of its decision.nn”Anthem’s decision to drop its planned modifier 25 policy is a positive step forward, demonstrating again that when doctors and health plans work together, the best outcome for patients can be achieved,” Resneck said. “This policy is one of a number of issues that the physician community has been working on with Anthem, and the AMA looks forward to continuing these efforts to find ways to collaborate on strategies to deliver affordable, high-quality, patient-centered care.”nnThe other issues include Anthem’s policies on the retrospective denial of payment for emergency room visits, restrictions on advanced imaging in hospital outpatient facilities, and the denial of payment for monitored anesthesia care or general anesthesia for cataract surgery.nn”Anthem remains committed to continuing to work with the AMA, state medical associations and national medical specialty societies to address physician concerns with the company’s policies and guidelines,” Samitt said, adding he looked forward to together tackling rising healthcare costs in a meaningful way.nnOriginal article posted on healthcarefinancenews.com.
Feb 22, 2018 | Uncategorized
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:nnThe 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.nnThe 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.nnIn 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.”nnYakely 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.nnCMS stands by its original request that Anthem retract the new modifier 25 policy without delay. Watch for more information as this issue develops.nnNews updates provided by Colorado Medical Society, February 19, 2018.
Feb 16, 2018 | Uncategorized
Leading insurance company, Aetna has been under investigation for insurance claim reviews by former medical director for the company. Health insurance is a tough industry to navigate to ensure proper charges and reimbursement but Welter Healthcare Partners is ready to help! Contact us today to see how we can help your practice so you can get back to treating patients!nn
nn nnCalifornia’s insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients’ records when deciding whether to approve or deny care.nnCalifornia Insurance Commissioner Dave Jones expressed outrage after CNN showed him a transcript of the testimony and said his office is looking into how widespread the practice is within Aetna.nn”If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that’s of significant concern to me as insurance commissioner in California — and potentially a violation of law,” he said.nnAetna, the nation’s third-largest insurance provider with 23.1 million customers, told CNN it looked forward to “explaining our clinical review process” to the commissioner.nnThe California probe centers on a deposition by Dr. Jay Ken Iinuma, who served as medical director for Aetna for Southern California from March 2012 to February 2015, according to the insurer.nnDuring the deposition, the doctor said he was following Aetna’s training, in which nurses reviewed records and made recommendations to him.nnJones said his expectation would be “that physicians would be reviewing treatment authorization requests,” and that it’s troubling that “during the entire course of time he was employed at Aetna, he never once looked at patients’ medical records himself.”nn”It’s hard to imagine that in that entire course in time, there weren’t any cases in which a decision about the denial of coverage ought to have been made by someone trained as a physician, as opposed to some other licensed professional,” Jones told CNN.nn”That’s why we’ve contacted Aetna and asked that they provide us information about how they are making these claims decisions and why we’ve opened this investigation.”nnThe insurance commissioner said Californians who believe they may have been adversely affected by Aetna’s decisions should contact his office.nnMembers of the medical community expressed similar shock, saying Iinuma’s deposition leads to questions about Aetna’s practices across the country.nn”Oh my God. Are you serious? That is incredible,” said Dr. Anne-Marie Irani when told of the medical director’s testimony. Irani is a professor of pediatrics and internal medicine at the Children’s Hospital of Richmond at VCU and a former member of the American Board of Allergy and Immunology’s board of directors.nn”This is potentially a huge, huge story and quite frankly may reshape how insurance functions,” said Dr. Andrew Murphy, who, like Irani, is a renowned fellow of the American Academy of Allergy, Asthma and Immunology. He recently served on the academy’s board of directors.nnClick here to read original article in it’s entirety on cnn.com.
Feb 8, 2018 | Uncategorized
New information has been released by the Centers for Medicare and Medicaid Services, for new medicare cards, being sent beginning April 1, 2018. Read below for complete details so you can stay informed and know what to expect.nnNew Medicare Card: Web UpdatesnTo help you prepare for the transition to the Medicare Beneficiary Identifier (MBI) on Medicare cards beginning April 1, 2018, review the new information about remittance advices.nnBeginning in October 2018, through the transition period, when providers submit a claim using a patient’s valid and active Health Insurance Claim Number (HICN), CMS will return both the HICN and the MBI on every remittance advice. Here are examples of different remittance advices:n
nFind more new information on the New Medicare Card provider webpage.nnNew Medicare Card: When Will My Medicare Patients Receive Their Cards?nStarting April 2018, CMS will begin mailing new Medicare cards to all people with Medicare on a flow basis, based on geographic location and other factors. Learn more about the Mailing Strategy. Also starting April 2018, your patients will be able to check the status of card mailings in their area on Medicare.gov.nnFor More Information:n
nThis article provided by Centers for Medicare and Medicaid Services.
Feb 1, 2018 | Uncategorized
Welter Healthcare Partners is excited to present our new Code Spotlight! Each month, Welter Healthcare Partners will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders.nnCorrect CPT and ICD-10 Codes with modifiers and units:nn27658 (LT modifier) – Repair, flexor tendon, leg; primary, without graft, each tendonnnS86.312A – Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, left leg, initial encounter
Jan 25, 2018 | Uncategorized
nFederal funding to run through September 2023nnDenver, CO – Congress approved a long-term, six-year funding extension for the Children’s Health Insurance Program known as Child Health Plan Plus (CHP+) in Colorado. CHP+ covers more than 75,000 kids and nearly 800 pregnant women in Colorado.nnThe Department of Health Care Policy and Financing (Department) will be notifying members that the program will continue after the bill is signed into law by the President.nn”Congress took an important step forward and found a long-term solution to restore federal funding for the Children’s Health Insurance Program,” said Kim Bimestefer, executive director for the Department. “We look forward to the President signing this bill as it will lift the burden of uncertainty from families throughout Colorado and allow them to continue to access the health care services that children and pregnant women need.”nn
The Department will be posting copies of the CHP+ member notification letters and additional information over the coming week to its “Future of CHP+” web page at CO.gov/HCPF/FutureCHP.nnIf a CHP+ family receives a letter stating it is time to renew their CHP+ benefits, they should follow the instructions in the letter and pay their enrollment fee, if they owe one. Failure to pay their enrollment fee, may result in not having coverage.nnAbout the Colorado Department of Health Care Policy and Financing:nnThe Department administers Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus as well as a variety of other programs for Coloradans who qualify. For more information about the Department, please visit Colorado.gov/hcpf.
