Health Net to rescind modifier 25 and emergency services payment policies

CAL/AAEM News Service calaaem.news.service at gmail.com
Fri Jun 29 09:58:45 PDT 2018



 

June 25, 2018

 

Health Net to rescind modifier 25 and emergency services payment policies

 

CMA Net <http://www.cmanet.org/cma-alert/archives/2018/june-25-2018/#1> 

 

In March, Health Net notified physicians of planned changes to its modifier
25 and emergency services payment policies for Medicare and Medi-Cal lines
of business. The California Medical Association (CMA) was opposed to these
policies and has been working in coordination with many national and state
specialty organizations to push back on the proposed changes. 

 

Health Net has announced to CMA that it will not proceed with implementation
of its modifier -25 and emergency services payment policies in California.
Health Net will be sending out an official notice to physicians about the
change. Additionally, Health Net has expressed a commitment to work with CMA
and others to implement an educational program focused on providing data and
feedback to physicians, as well as information on proper coding practices
for emergency department services. 

 

The policies at issue would have cut reimbursement of an evaluation and
management service with modifier 25 by 50 percent when billed with a minor
surgical procedure or a preventive visit (CC.PP.052 and CC.PP.057).
Additionally, Health Net planned to implement a Non-Emergent Emergency Room
policy (CC.PP.053), which would have reduced reimbursement for Level 4
(99284) and Level 5 (99285) emergency services to a Level 3 (99283)
reimbursement rate if Health Net deemed the diagnosis was non-emergent.

 

Last month, at CMA's urging, Health Net agreed to delay implementation of
the new policies until July 1, 2018, to allow time to review provider
concerns with the new policies and to continue discussions with CMA and
other stakeholders.

 

CMA appreciates the collaborative dialogue with Health Net and its
willingness to work with CMA and physicians to identify alternative
strategies to address proper coding and cost concerns. We believe that
Health Net's decision reflects a growing recognition of the need for a
different type of engagement between health plans and the physician
community to improve health care quality, access and affordability. 

 

 

Jeff Wells
Deputy Editor, CAL/AAEM News Service

 

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service



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