Sen. Richard Blumenthal is urging Cigna to rescind a new policy he said will create “onerous administrative burdens for physicians, needlessly raises costs for healthcare providers and jeopardizes patient care.”
Beginning Oct. 1, Cigna’s new Evaluation and Management Coding Accuracy policy will review CPT evaluation and management codes 99204-99205, 99214-99215, and 99244-99245 for billing and coding accuracy. Some services may be adjusted by one level when guidelines are not met.
“To better align with the American Medical Association’s Evaluation and Management services guidelines, Cigna Healthcare will implement a new reimbursement and coding accuracy policy for E/M codes that are being inappropriately billed as a higher level,” a Cigna spokesperson told Becker’s. “This review will only apply to approximately 3% of in-network physicians who have a consistent pattern of coding at a higher E/M level compared to their peers. Claims will be individually reviewed for coding accuracy and payment may be adjusted by one level to meet AMA guidelines. Physicians may request reconsideration or appeal our decision if they feel the higher payment is appropriate.”
Mr. Blumenthal outlined his concerns about the policy in a Sept. 11 letter to Cigna Health Chief Medical Officer Amy Flaster, MD. Among those concerns is a requirement that physicians file written appeals for each claim that is automatically downcoded. He said many physicians, especially those running small practices, “will have to sacrifice valuable time to file paperwork disputing billing errors.”
“This policy needlessly raises costs and threatens patient care and the stability of physician practices across the country,” he said in the letter.
The California and Texas medical associations have also urged Cigna to rescind the policy, echoing concerns it will increase administrative burdens, as well as create a barrier to appropriate reimbursement.
The medical associations said Cigna should halt the policy and instead focus on educating coding outliers.
