Backlash against the ridiculous idea of blended payment rates:
“Paying a blended rate (an average of several CPT codes determined by the health plan) for Levels 3, 4 and 5 office visits contradicts the concept of a resource-based relative value scale upon which the Medicare rates are based,” said the letter. Higher-level office visits cost more for a reason: Not only does the physician spend more time taking the patient’s history and completing the medical exam, he or she performs at a higher level of decision making, continued the letter.“Medicare, the largest payer in the United States, recognizes and pays more for the higher levels of office visits on this basis, and we believe CIGNA HealthCare should, too,” said the letter.
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{ 5 comments }
Smells like downcoding. The carrier probably discovered itself making larger payouts once proper documentation was applied and they didn’t like having to pay for what their insureds were using.
I would dump any insurance company that did this to my claims. I already dumped Cigna.
To take a contrarian view, blending the codes to a uniform “office visit” fee may even the playing field and simplify life for office-based physicians. I feel that I’m spending too much time and effort worrying about the criteria for a 99213 vs 99214 office visit. Also we all know that may physicians successfully game the system with electronic records and other documentation systems that we all know put more on paper than was actually done. I would favor a basic three tiered payment system for brief, intermediate, and comprehensive services with additional payment for a new patient. The current system is a joke, and we all know it.
In response to anonymous 12:08,
Certainly I think we would all welcome a simpler, fair system, but I doubt the insurance companies are just trying to make our lives less complicated.
No, I’m sure the insurance companies aren’t doing it to make life simpler. In fact the current system was actually designed by the AMA which is one of the main reasons why I am not a member.
Excellent point Anon 4:01pm.
Blended codes are a method of forcing doctors to see more patients per unit of time.
This promotes the 8 minute per visit syndrome, inattention to the big picture, and mistakes, with subsequent increased malpractice risk, a risk not born by the insurance company.
The insurance companies know exactly what they are doing.
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