Anthem to cut pay for some same-day services by 25%: 4 things to know


https://www.beckershospitalreview.com/payer-issues/anthem-to-cut-pay-for-some-same-day-services-by-25-4-things-to-now.html

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Anthem Blue Cross Blue Shield plans to reduce payment by 25 percent for some separate services administered on the same day as a wellness exam or another procedure.

Here are four things to know about the proposed policy.

1. The insurer lowered the planned payment cut for some same-day services from 50 percent to 25 percent following pushback from the American Medical Association. Anthem also postponed the rollout of the cuts — initially slated for Jan. 1 — to March 1, 2018. The insurer postponed implementation after AMA sent a letter to Anthem and met with senior Anthem officials to oppose the policy.

2. One example the Kentucky Medical Association provided of a same-day service that may face payment reduction is the instance of a patient coming in for a nosebleed. After the physician packs a patient’s nose to stop the bleeding, the physician may evaluate the patient for moderate hypertension and adjust their medication. In this instance, KMA argued, the hypertension service was medically necessary, though separate from packing the nose.

3. The policy begins March across the following states: California, Colorado, Connecticut, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio and Wisconsin. The policy will also take effect in Georgia and Virginia after network contract renewal.

4. Jack Resneck Jr., MD, chair-elect of the AMA board of trustees, said, “Anthem’s decision to reduce the magnitude of the proposed payment cuts in response to evidence supplied by AMA is a positive step. However, the AMA continues to challenge Anthem’s rationale for the unjustified 25 percent reduction proposed in the revised policy.”

 

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