While praising insurance company Anthem for changing one aspect of its reimbursement policy, the Access to Medical Imaging Coalition (AMIC) is still encouraging Anthem to revisit its new policies for reimbursement of advanced imaging studies performed in the hospital outpatient setting.
After receiving feedback from several medical societies, Anthem decided not to go ahead with its reimbursement policy pertaining to physician use of current procedural terminology (CPT) modifier 25. However, AMIC said it remains concerned about Anthem's other new policies for outpatient imaging and emergency department use.
One of these policies directs patients who need an MRI or CT scan away from hospital-based outpatient imaging services, which can disrupt the ordering physicians' relationships with radiology practices and can dramatically reduce patients' options as to where the imaging is performed, according to AMIC. The organization said the Anthem policy largely denies reimbursement for these studies if they are performed in the hospital outpatient setting.
In addition, AMIC said that Anthem has initiated retrospective reviews of all services -- including scans -- administered in the emergency department in select states. If these services are deemed to be nonemergent, Anthem will retrospectively deny coverage and force the patient to cover the expenses, according to AMIC.
"Such a policy unfairly shifts the responsibility for determining the difference between an emergent or nonemergent situation to the patient," AMIC said.
