Anthem Blue Cross announces further changes to reimbursement policies and claims software July 6, 2015 General, Managed Care Anthem Blue Cross, Insurance/Reimbursement 0 Anthem Blue Cross recently notified physicians of additional upcoming changes to its reimbursement policies and claims editing software, ClaimsXten. The additional changes, scheduled to go into effect on September 14, 2015, come less than 90 days after Anthem’s most recent set of changes were implemented in July, and less than a month prior to the implementation of ICD-10. Anthem states that the additional changes are necessary to bring its claims editing system in line with correct coding guidelines. Anthem did not provide a detailed listing of all the incorporated changes; rather, it provided a reference sheet showing examples of the types of edits that will be incorporated as part of its September update. Concerned that the lack of detail could lead to confusion for physician practices on one policy change, the California Medical Association (CMA) asked Anthem for clarity on the Inpatient Evaluation and Management (E/M) services example. Specifically, the first example states, “Inpatient Evaluation and Management services (i.e., inpatient admission, observation services, and consultation services) should be billed only once by the same provider during an inpatient stay.” CMA asked Anthem to clarify whether the scope of the change is limited to the three services listed or whether it includes other inpatient E/M services. Anthem has advised CMA that the intent of the policy change is to prevent multiple physicians from billing for the same service on the same date. For example, only one physician should bill for an inpatient admission E/M service. The payor further clarified that the policy change applies to any inpatient E/M services which do not warrant multiple physician claims, such as the three listed, and also includes discharges. Additionally, Anthem will implement edits to ensure appropriate usage of modifiers -54, 55, 56, 76, 77, 78 and 79, as well as modifiers -26 and TC. Because of these changes, physicians may notice a difference in how certain codes and code pairs are adjudicated. Along with the notice, Anthem enclosed copies of several reimbursement policies including its Bundled Services and Supplies policy (CA – 0008); Assistant Surgeon Services policy (CA-0009); and Modifiers 59 and XE, XP, XS & XU (Distinct Procedural/Separate/Unusual Service) policy (CA-0023) that were updated since the mailing in March. Physicians are encouraged to review all of the claims editing changes as well as the corresponding detailed payment policies to understand how the changes will affect their individual practices. Physicians can also access this information via the Blue Cross ProviderAccess website (log in, then select “Reimbursement Policies and McKesson ClaimsXten Rules” under the “What’s New” section). Questions about any of the claims editing rules or payment policies can be directed to the Anthem Provider Care Department at (800) 677-6669 FREE. Contact: CMA reimbursement helpline, (888) 401-5911 FREE or economicservices@cmanet.org. Comments are closed.
