The California Medical Association is pushing back on a paperwork demand reintroduced by Cigna, arguing that the requirement "will result in significant, unnecessary administrative burdens and compliance costs."
Cigna's policy will require the submission of medical records for all evaluation and management claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed. It is set to go into effect May 25.
The CMA said it is the same policy that it and the American Medical Association opposed last year. Cigna paused the requirement that was originally set to go into effect in August.
In a March 29 letter to Cigna, the CMA said the policy will impose an estimated cost of approximately $7.88 to $8.13 per claim on the provider to produce the record and fax or email it to the payer. The CMA said this will result in a net payment reduction on each claim.
The group said the policy change will also cost physicians time that would be better spent scheduling and caring for patients and "wastes scarce health care dollars, particularly
when Cigna has not provided physicians with a credible rationale for the policy change."
"We believe a more collaborative approach to utilize alternative methodologies for cost containment, including provider education on proper coding practices that do not bluntly penalize physicians using the modifier appropriately as outlined to Cigna by CMA and AMA last year will prove more effective and less costly in the long term," the California Medical Association said in its letter.