A disturbing trend – Insurers are starting to blend 99213 and 99214 payments:
Of special concern are letters sent to OAFP members in northern and central Ohio questioning their overuse of the 99214 code and the decision by Anthem in southern Ohio to blend payment rates for 99213 and 99214 codes. While Anthem denied the intent of devaluing primary care services, this is certainly the perception among some family physicians. As we all know, “perception is reality.”
What they are doing is increasing reimbursement of a 99213 and decreasing a 99214 – giving a single “blended” code. This is in response to the increased 99214 that physicians are coding using improved documentation from EHRs.
Total crap I say. On one hand, physicians are asked bear the cost of purchasing expensive EHRs, yet when this results in increased (and appropriate) coding, reimbursement is further cut. A possible response:
A possible backlash against the outlier letters was mentioned as well. OAFP leaders suggested that physicians may break their typical 99214 visits into several 99213 visits instead of addressing multiple symptoms at one time. Studies have shown that family physicians typically manage 3.05 problems per encounter and bill 1.97 problems.