Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 A direct corollary to that: the only two insurances (basically) I don't take are Cigna & Anthem. Blending of payments I haven't followed recent posts, so maybe this has already been addressed. This weblink goes to an AAFP article talking about Cigna's policy (and Anthem in Ohio) of making -213 -214 and -215 payments " blended " in one. Yet another effort to up the insurance profits and stick it to the physician once again--and who gets most affected by this--the office visit leveraged family physician (versus procedure specialists). I think someone's trying to turn off the ventilator on the future of primary care. http://www.aafp.org/x42512.xml CB Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 A direct corollary to that: the only two insurances (basically) I don't take are Cigna & Anthem. Blending of payments I haven't followed recent posts, so maybe this has already been addressed. This weblink goes to an AAFP article talking about Cigna's policy (and Anthem in Ohio) of making -213 -214 and -215 payments " blended " in one. Yet another effort to up the insurance profits and stick it to the physician once again--and who gets most affected by this--the office visit leveraged family physician (versus procedure specialists). I think someone's trying to turn off the ventilator on the future of primary care. http://www.aafp.org/x42512.xml CB Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 Question for those in areas where this is taking place. Is the payment closer to what you would get for a 99213 or a 99214 (given that 99215s are also blended in)? I mean, if the insurances are paying only 99213 prices, then they are effectively downcoding, but if they are paying higher than that, I would guess some dysfunctional practices that run everyone out with a 99213 code would stand to make money. So although it encourages even more quantity over quality, I would guess not all practices would be losing out on this. Blending of payments I haven't followed recent posts, so maybe this has already been addressed. This weblink goes to an AAFP article talking about Cigna's policy (and Anthem in Ohio) of making -213 -214 and -215 payments " blended " in one. Yet another effort to up the insurance profits and stick it to the physician once again--and who gets most affected by this--the office visit leveraged family physician (versus procedure specialists). I think someone's trying to turn off the ventilator on the future of primary care. http://www.aafp.org/x42512.xml CB Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 Question for those in areas where this is taking place. Is the payment closer to what you would get for a 99213 or a 99214 (given that 99215s are also blended in)? I mean, if the insurances are paying only 99213 prices, then they are effectively downcoding, but if they are paying higher than that, I would guess some dysfunctional practices that run everyone out with a 99213 code would stand to make money. So although it encourages even more quantity over quality, I would guess not all practices would be losing out on this. Blending of payments I haven't followed recent posts, so maybe this has already been addressed. This weblink goes to an AAFP article talking about Cigna's policy (and Anthem in Ohio) of making -213 -214 and -215 payments " blended " in one. Yet another effort to up the insurance profits and stick it to the physician once again--and who gets most affected by this--the office visit leveraged family physician (versus procedure specialists). I think someone's trying to turn off the ventilator on the future of primary care. http://www.aafp.org/x42512.xml CB Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 isn't blending a violation of the insurance company's contract with the physician? if so, have the violations been reported to the various state's insurance commissioners? i thought the academy's response to blending, reported in the article, was verrrrrry milquetoast. if we permit this kind of crap, we'll all be practicing out of refrigerator boxes underneath railroad trestles. LL" Brady, MD" wrote: Question for those in areas where this is taking place. Is the payment closer to what you would get for a 99213 or a 99214 (given that 99215s are also blended in)? I mean, if the insurances are paying only 99213 prices, then they are effectively downcoding, but if they are paying higher than that, I would guess some dysfunctional practices that run everyone out with a 99213 code would stand to make money. So although it encourages even more quantity over quality, I would guess not all practices would be losing out on this. -----Original Message-----From: [mailto: ] On Behalf Of brownbears74Sent: Thursday, March 09, 2006 10:33 AMTo: Subject: Blending of payments I haven't followed recent posts, so maybe this has already beenaddressed. This weblink goes to an AAFP article talking about Cigna'spolicy (and Anthem in Ohio) of making -213 -214 and -215 payments"blended" in one. Yet another effort to up the insurance profits andstick it to the physician once again--and who gets most affected bythis--the office visit leveraged family physician (versus procedurespecialists). I think someone's trying to turn off the ventilator onthe future of primary care.http://www.aafp.org/x42512.xmlCB Yahoo! Mail Bring photos to life! New PhotoMail makes sharing a breeze. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 One correction to my previous post-- it is only -213 and -214's that are being blended (for now). I imagine that is to punish the minority that are coding more -214's and try to gain favor with those billing mostly -213's. Quite a clever chess move, it would seem. CB > > > v\:* {behavior:url(#default#VML);} o\:* {behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} ..shape {behavior:url(#default#VML);} Question for those in areas where this is taking place. Is the payment closer to what you would get for a 99213 or a 99214 (given that 99215s are also blended in)? I mean, if the insurances are paying only 99213 prices, then they are effectively downcoding, but if they are paying higher than that, I would guess some dysfunctional practices that run everyone out with a 99213 code would stand to make money. So although it encourages even more quantity over quality, I would guess not all practices would be losing out on this. > > > Blending of payments > > I haven't followed recent posts, so maybe this has already been > addressed. This weblink goes to an AAFP article talking about Cigna's > policy (and Anthem in Ohio) of making -213 -214 and -215 payments > " blended " in one. Yet another effort to up the insurance profits and > stick it to the physician once again--and who gets most affected by > this--the office visit leveraged family physician (versus procedure > specialists). I think someone's trying to turn off the ventilator on > the future of primary care. > > http://www.aafp.org/x42512.xml > > CB > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 One correction to my previous post-- it is only -213 and -214's that are being blended (for now). I imagine that is to punish the minority that are coding more -214's and try to gain favor with those billing mostly -213's. Quite a clever chess move, it would seem. CB > > > v\:* {behavior:url(#default#VML);} o\:* {behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} ..shape {behavior:url(#default#VML);} Question for those in areas where this is taking place. Is the payment closer to what you would get for a 99213 or a 99214 (given that 99215s are also blended in)? I mean, if the insurances are paying only 99213 prices, then they are effectively downcoding, but if they are paying higher than that, I would guess some dysfunctional practices that run everyone out with a 99213 code would stand to make money. So although it encourages even more quantity over quality, I would guess not all practices would be losing out on this. > > > Blending of payments > > I haven't followed recent posts, so maybe this has already been > addressed. This weblink goes to an AAFP article talking about Cigna's > policy (and Anthem in Ohio) of making -213 -214 and -215 payments > " blended " in one. Yet another effort to up the insurance profits and > stick it to the physician once again--and who gets most affected by > this--the office visit leveraged family physician (versus procedure > specialists). I think someone's trying to turn off the ventilator on > the future of primary care. > > http://www.aafp.org/x42512.xml > > CB > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 The blended rates are about mid-way between a 99213 & 99214 rate (BTW, same thing is happening with the 99203/99204 codes). Yes, that was Anthem’s response: that most practices (ie, notorious undercoders) stood to make more while the minority of practices coding higher (ie, those with EMR’s) would lose some. I think they will be challenged legally on this soon. This has to be a violation of their recent class action settlement, and several of the Ohio med societies have been giving subtle hints to Anthem that this might be the next step. If the trend is not halted, I’m sure we would soon just see one flat “office call” fee (ie, $45 no matter how you chart it/code it/time spent). & total disregard of all CPT guidelines. Blending of payments I haven't followed recent posts, so maybe this has already been addressed. This weblink goes to an AAFP article talking about Cigna's policy (and Anthem in Ohio) of making -213 -214 and -215 payments " blended " in one. Yet another effort to up the insurance profits and stick it to the physician once again--and who gets most affected by this--the office visit leveraged family physician (versus procedure specialists). I think someone's trying to turn off the ventilator on the future of primary care. http://www.aafp.org/x42512.xml CB Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2006 Report Share Posted March 10, 2006 The article I read indicated that Anthem had experience a marked increase in 99214's from prior year. They attributed the higher level of 214's as from physicians with EMR's. The blended rate was higher than a 99213 but for physicians with a higher percentage 99214 than 99213 the rate was enough to ensure that the efficient coders doing more documentation could not increase revenue and would actually decrease revenue. ie 992123 = $25 99214 = $50; blended = $32. Compensation for combination of 2 213's, one 213 and 1 214, or 2 214s; 50, 75, 100. Blended 64 a gain for the under coder, but a loss for those with longer visits and higher codes. brownbears74 wrote: One correction to my previous post-- it is only -213 and -214's thatare being blended (for now). I imagine that is to punish the minoritythat are coding more -214's and try to gain favor with those billingmostly -213's. Quite a clever chess move, it would seem.CB> > > v\:* {behavior:url(#default#VML);} o\:*{behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);} Question for thosein areas where this is taking place. Is the payment closer to what youwould get for a 99213 or a 99214 (given that 99215s are also blendedin)? I mean, if the insurances are paying only 99213 prices, then theyare effectively downcoding, but if they are paying higher than that, Iwould guess some dysfunctional practices that run everyone out with a99213 code would stand to make money. So although it encourages evenmore quantity over quality, I would guess not all practices would belosing out on this. > > > Blending of payments> > I haven't followed recent posts, so maybe this has already been> addressed. This weblink goes to an AAFP article talking about Cigna's> policy (and Anthem in Ohio) of making -213 -214 and -215 payments> "blended" in one. Yet another effort to up the insurance profits and> stick it to the physician once again--and who gets most affected by> this--the office visit leveraged family physician (versus procedure> specialists). I think someone's trying to turn off the ventilator on> the future of primary care.> > http://www.aafp.org/x42512.xml> > CB> > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2006 Report Share Posted March 10, 2006 The problem I see with this move is that it creates a greater push to fragment care in multiple sequential office visits, increasing the risk that a patient will not follow through with chronic care management, and actually driving up cost in most office practices. It sets the stage for churning. This trend is disastrous. It increases the push to exit this insanely burdensome and expensive insurance system, as the insurance system is making primary care increasingly impossible. Gordon At 12:33 PM 3/9/2006, you wrote: The blended rates are about mid-way between a 99213 & 99214 rate (BTW, same thing is happening with the 99203/99204 codes). Yes, that was Anthem’s response: that most practices (ie, notorious undercoders) stood to make more while the minority of practices coding higher (ie, those with EMR’s) would lose some. I think they will be challenged legally on this soon. This has to be a violation of their recent class action settlement, and several of the Ohio med societies have been giving subtle hints to Anthem that this might be the next step. If the trend is not halted, I’m sure we would soon just see one flat “office call” fee (ie, $45 no matter how you chart it/code it/time spent). & total disregard of all CPT guidelines. Blending of payments I haven't followed recent posts, so maybe this has already been addressed. This weblink goes to an AAFP article talking about Cigna's policy (and Anthem in Ohio) of making -213 -214 and -215 payments " blended " in one. Yet another effort to up the insurance profits and stick it to the physician once again--and who gets most affected by this--the office visit leveraged family physician (versus procedure specialists). I think someone's trying to turn off the ventilator on the future of primary care. http://www.aafp.org/x42512.xml CB Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2006 Report Share Posted March 10, 2006 Playing devil’s advocate for a minute. Is it really the concept of blending or the total reimbursement that is offensive? I for one would be in favor of a single payment for all 99213 and 99214 if that payment was closer to the 99214 than the 99213 reimbursement. I believe the current system is so wrought with subjectiveness (remember the whole medical necessity question—even if you spend the time and do a thorough exam was it truly medically necessary based on the diagnoses) that it constantly sets the physician up for insurance fraud. This type of system would eliminate that fear all together. I certainly believe that the blending has to have some other systems to encourage quality in it (ex do you have an EMR—great! You get an additional 10%) otherwise the insurances are pushing quantity even more (thus effectively killing any quality advances), but the general idea of getting paid without fearing retribution is actually appealing to me—as long as the reimbursement is reasonable. Blending of payments > > I haven't followed recent posts, so maybe this has already been > addressed. This weblink goes to an AAFP article talking about Cigna's > policy (and Anthem in Ohio) of making -213 -214 and -215 payments > " blended " in one. Yet another effort to up the insurance profits and > stick it to the physician once again--and who gets most affected by > this--the office visit leveraged family physician (versus procedure > specialists). I think someone's trying to turn off the ventilator on > the future of primary care. > > http://www.aafp.org/x42512.xml > > CB > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2006 Report Share Posted March 10, 2006 That was basically the same thing that the Ohio State Medical Association (OSMA) and the Ohio Osteopathic Association (OOA) told Anthem when they met with them to discuss this blending and to voice concerns. Blending of payments I haven't followed recent posts, so maybe this has already been addressed. This weblink goes to an AAFP article talking about Cigna's policy (and Anthem in Ohio) of making -213 -214 and -215 payments " blended " in one. Yet another effort to up the insurance profits and stick it to the physician once again--and who gets most affected by this--the office visit leveraged family physician (versus procedure specialists). I think someone's trying to turn off the ventilator on the future of primary care. http://www.aafp.org/x42512.xml CB SPONSORED LINKS Family health care Family health care plan Family Family health care coverage Family practice physician jobs Family health care network YAHOO! GROUPS LINKS · Visit your group " " on the web. · · Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2006 Report Share Posted March 10, 2006 Oh of course, that would be great if the reimbursement were closer to the 99214 rate for the blended code! We could document less (ie, 99213 criteria) & get paid the same. I’m sure that is not going to happen though. Also, Anthem for one takes the subtle intimidation one step further: you have to automatically send notes with any claims submitted for a 99215 or 99205. So, now there is this disincentive to code anything higher than a 99213 or 99202. I take every chance I get to slam Anthem when people ask why I don’t accept it in my office (“come on doc, Anthem is great insurance, why would you not take it?”). It is ironic that patient’s have this allusion still that the “BCBS” label still means top of the line insurance, when actually the opposite is true: it is essentially becoming the new Medicaid. Blending of payments > > I haven't followed recent posts, so maybe this has already been > addressed. This weblink goes to an AAFP article talking about Cigna's > policy (and Anthem in Ohio) of making -213 -214 and -215 payments > " blended " in one. Yet another effort to up the insurance profits and > stick it to the physician once again--and who gets most affected by > this--the office visit leveraged family physician (versus procedure > specialists). I think someone's trying to turn off the ventilator on > the future of primary care. > > http://www.aafp.org/x42512.xml > > CB > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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