ANTHEM PAYMENT
CHANGES WILL
AFFECT YOUR
PRACTICE
Anthem announced that as of January 1, 2018, the health insurance
provider will implement a policy in Kentucky (California, Connecti-
cut, Maine, Nevada, New Hampshire, Ohio and Wisconsin as well)
which will reduce reimbursement for Modifier 25. This policy will
affect claims processed January 1, which could include claims
made in 2017 that are processed on January 1 or later. This will
have major implications for those physicians enrolled in Anthem.
The payor will begin reducing reimbursement of evaluation and
management (E/M) services which are billed with Modifier 25 in
relation to two circumstances:
» » When a minor surgical procedure code (0 or 10-day global
period) is reported on the same day as an E/M code by the
same physician, payment for the E/M code will be reduced
by 50 percent.
» » When a preventative/wellness exam and a problem-oriented
E/M are billed during the same encounter, payment for the
problem-oriented E/M code will be reduced by 50 percent.
These changes will have adverse financial impacts on physician
members. GLMS physicians are urged to thoroughly review and
assess the impact that any proposed modifications would have
on their individual practices.
AMA has recently adopted a policy (https://www.ama-assn.org/
ama-adopts-additional-policies-2017-interim-meeting) in re-
sponse to Anthems policy to “aggressively and immediately ad-
vocate through any legal means possible, including direct payer
negotiations, regulations, legislation, or litigation, to ensure when
an evaluation and management (E&M) code is appropriately re-
ported with a modifier 25, that both the procedure and E&M codes
are paid at the non-reduced, allowable payment rate.”
KMA has put together a resource guide (https://kyma.
org/2017/11/22/modifier-madness-focus-on-modifier-25/) for
physicians on the Modifier 25 policy change.
We also encourage you to call Anthem at 800-205-5870 to
voice concerns about this change and how this will nega-
tively impact your practice and your patients or via email at
West.Team-KyProviderEngagement&Contracting@anthem.
com or East.Team-KyProviderEngagement&Contracting@
anthem.com.
We are continuing to advocate and fight for what is best for you
and the patients you serve.
FLEUR-DE-LIS CONNECTION | DECEMBER 2017
3