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Teamwork among ISMA, others nets policy reversal from Anthem
e-Reports, April 16, 2012
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Action to restore reimbursement on modifier 25 demonstrates how organized medicine advocates for physicians. Next time, it may involve YOUR specialty. Untitled document

An ongoing collaboration since January has benefitted dermatology practices, yet serves as an example of how the ISMA regularly works with specialty societies on behalf of physicians.

ISMA leaders meet twice a year with presidents of specialty societies in Indiana to discuss concerns and cooperate, as appropriate, on legislative and other priorities. The next meeting will be held in July.

The modifier 25 issue
A new Anthem Blue Cross and Blue Shield policy, introduced in a limited area, took effect Jan. 1. It reduced reimbursement by 50 percent for evaluation and management (E/M) services billed with modifier 25, in conjunction with procedure codes for dermatology.

The American Academy of Dermatology (AAD) became involved in the issue, conferring with dermatologists in southern Indiana and Kentucky, as well as the Indiana Academy of Dermatology, the Kentucky Medical Society and the ISMA. A letter detailing the situation went to the insurer in February.

In addition, the ISMA put the AAD in touch with ISMA Past President David Welsh, M.D., who serves on Wellpoint’s Physician Advisory Board. Dr. Welsh presented the dermatologists’ concerns at the next meeting of the board and was assured that the insurer would review the situation.

“Physicians’ concerns were heard and the insurer is now implementing changes,” said Dr. Welsh. “Whenever physicians have issues – whether related to public health, government or insurance – the ISMA listens and takes action to help whenever possible, fulfilling its mission to advocate for physicians and their patients.”

Achieving results
Late last month, the ADA received a response from Anthem/Wellpoint indicating that effective June 1, the company would begin reimbursing at 100 percent of the allowable amount for the procedure codes in question, rather than 50 percent as had been occurring. Wellpoint will maintain the 50 percent reduction for E/M codes billed with modifier 25 with a preventive visit code.

“Thank you for all the teamwork that went into this advocacy effort,” said Leslie Stein, AAD’s director of Regulatory and Payment Policy. “We are thrilled it was successful!”

Stay current on coding
Achieving success every day with claims reimbursement requires proper coding by physicians and their coders or billers. ISMA Practice Advisor Gloria Kirkham, CPC, CPC-I, a certified procedural coder and instructor, stressed the importance of following appropriate coding guidelines.

“New CPT codes become effective every Jan. 1.

It is important to have the most recent edition of the coding books among your coding resources,” she said. The books are available from various outlets; contact Kirkham via email for a listing.

“The ISMA website also has a full schedule of educational opportunities on coding,” Kirkham added. For details, see the ISMA website.

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