ACR Continues Practice Advocacy Efforts
The ACR, in conjunction with the Maryland Medical Society and support from 11 specialty societies, defeated a proposal before the Maryland Insurance Commission that contained language requiring all claims posted with “modifier 25” to be automatically pended before processing. An ACR-authored letter that opposed the contract language echoed the concern of many physicians of negative payment patterns such as down-coding and code-bundling allegedly practiced by insurance carriers in current class-action suits.
The ACR and members of the National Medical Specialty Society Health Insurance Coalition (Coalition) met with Anthem BC medical directors to address contract language revision such as bundling language, co-payment policies, key contacts, evidence-based medicine, and medical policy development. The ACR also reviewed Anthem BC policies concerning bone density, Humira, Hyalgen and Synvisc. Similarly, the ACR participated in the AMA Modifier Complaint Project by writing letters targeting major insurance carriers for non-recognition of CPT modifiers such as modifier 25. 57, 59, bundling/unbundling, and down-coding. The letters were sent to 28 national, regional, and local health plans representing 75% of the nation’s total covered lives, including Cigna, PHCS, MidAtlantic, Empire Blue Cross, and Oxford.
The Committee on Rheumatologic Care (CORC) of the ACR published a position paper on New Biologics in March and has submitted it to U.S. Pharmacopoeia (USP) and the American Society of Health Systems Pharmacists to secure recognition by insurance carriers nation-wide. Also, the ACR continues to work with the Coalition to meet with medical directors of the largest health insurance associations in order to open dialogue and address issues of concern including emerging technologies, medical policy development, billing, payment policy, and quality.
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