- The American Medical Association said Friday that Anthem has rescinded a policy that would have cut provider payments by 25% for separate evaluation and management services billed using CPT modifier 25 when a different procedure or service is performed on the same day. The move was the latest by the payer to aggressively cut costs, eliciting pushback from providers.
- Since announcing the E/M cut planned for 14 states, Anthem had already reduced the cut from 50% and delayed the onset for two months. AMA had said the policy would force patients to make unnecessary extra visits and could delay needed care.
- AMA said the payer’s move was “in response to strong objection from the AMA and other physician groups” and added Anthem “has expressed commitment to continuing to work with the AMA, state medical associations, and national medical specialty societies to address physician concerns with other policies and guidelines."
Anthem’s backtrack is a win for the AMA, and a sign the payer may be feeling the heat after protests of similar cost-cutting measures enacted in the past several months. Those include refusing to pay for MRIs and CT scans performed at hospitals on an outpatient basis, limiting the coverage of anesthesiologists during cataract surgery and reviewing emergency room claims and denying those it deems medically unnecessary.
Anthem showed signs of walking back these policies earlier this year when it made exceptions for the ER restrictions, including visits for children and those that happen on a weekend or holiday.
The payer has, however, stood by its overall push for moving more services to lower cost settings. In an earlier statement to Healthcare Dive, the company said it seeks to “reduce the cost of healthcare while simultaneously improving the quality and efficiency of the healthcare system for consumers.”
Anthem was not available for comment.
The backlash Anthem has seen could make other insurers think twice about restrictions and cuts, but the drive for lowering costs, and the power a concentrated payer market can have over providers will remain.