RE: Re: Blending 99213/99214s

[Guest guest]

,WOW! those rates are horrible. They are much lower than our regional reimbursement.The blended rates are extra bad news for those of us providing high quality care (which does take more than 15 minutes most of the time!)PamelaPamela Wible, MDFamily & Community Medicine, LLC3575 st. #220 Eugene, OR 97405roxywible@...On Mar 9, 2006, at 5:13 PM, Egly wrote: The article I read indicated that Anthem had experience a marked increase in 99214's from prior year.  They attributed the higher level of 214's as from physicians with EMR's.  The blended rate was higher than a 99213 but for physicians with a higher percentage 99214 than 99213 the rate was enough to ensure that the efficient coders doing more documentation could not increase revenue and would actually decrease revenue.  ie 992123 = $25  99214 = $50; blended = $32.  Compensation for combination of 2 213's, one 213 and 1 214, or 2 214s;  50, 75, 100.  Blended 64 a gain for the under coder, but a loss for those with longer visits and higher codes.   brownbears74 wrote: One correction to my previous post-- it is only -213 and -214's thatare being blended (for now).  I imagine that is to punish the minoritythat are coding more -214's and try to gain favor with those billingmostly -213's.  Quite a clever chess move, it would seem.CB>         > >     v\:* {behavior:url(#default#VML);}  o\:*{behavior:url(#default#VML);}  w\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);}                Question for thosein areas where this is taking place. Is the payment closer to what youwould get for a 99213 or a 99214 (given that 99215s are also blendedin)? I mean, if the insurances are paying only 99213 prices, then theyare effectively downcoding, but if they are paying higher than that, Iwould guess some dysfunctional practices that run everyone out with a99213 code would stand to make money. So although it encourages evenmore quantity over quality, I would guess not all practices would belosing out on this. >   >    >   Blending of payments>    >   I haven't followed recent posts, so maybe this has already been> addressed.  This weblink goes to an AAFP article talking about Cigna's> policy (and Anthem in Ohio) of making -213 -214 and -215 payments> "blended" in one.  Yet another effort to up the insurance profits and> stick it to the physician once again--and who gets most affected by> this--the office visit leveraged family physician (versus procedure> specialists).  I think someone's trying to turn off the ventilator on> the future of primary care.> > http://www.aafp.org/x42512.xml> > CB> > > > > > > >  

[Guest guest]

I assumed those numbers he threw out there

were hypothetical. I don’t think the 99213/99214 blended rate is

actually $32, at least not here in Ohio. I think it is ~$50. A 99213 definitely pays more than

$25 and a 99214 definitely pays more than $50 here. Those sound more like

Medicaid rates.

Blending of

payments

>

> I haven't followed recent posts,

so maybe this has already been

> addressed. This weblink goes to an AAFP

article talking about Cigna's

> policy (and Anthem in Ohio) of making -213

-214 and -215 payments

> " blended " in one. Yet another

effort to up the insurance profits and

> stick it to the physician once again--and who

gets most affected by

> this--the office visit leveraged family

physician (versus procedure

> specialists). I think someone's trying

to turn off the ventilator on

> the future of primary care.

>

> http://www.aafp.org/x42512.xml

>

> CB

>

>

>

>

>

>

>

>

[Guest guest]

Pam: Sorry for the mis representation. Those rates were an example of how they blended rates. I did not have the original article to quote. They claimed total expenditure would be about the same, but the dollars would be redistributed based on the new blended rate. This would make the process fair, but remove the incentive to provide 99214 care to all patients. pamela wible wrote: , WOW! those rates are horrible. They are much lower than our regional reimbursement. The blended rates are extra bad news for those of us providing high quality care (which does take more than 15 minutes most of the time!) Pamela Pamela Wible, MD Family & Community Medicine, LLC 3575 st. #220 Eugene, OR 97405 roxywible@... The article I read indicated that Anthem had experience a marked increase in 99214's from prior year. They attributed the higher level of 214's as from physicians with EMR's. The blended rate was higher than a 99213 but for physicians with a higher percentage 99214 than 99213 the rate was enough to ensure that the efficient coders doing more documentation could not increase revenue and would actually decrease revenue. ie 992123 = $25 99214 = $50; blended = $32. Compensation for combination of 2 213's, one 213 and 1 214, or 2

214s; 50, 75, 100. Blended 64 a gain for the under coder, but a loss for those with longer visits and higher codes. brownbears74 wrote: One correction to my previous post-- it is only -213 and -214's thatare being blended (for now). I imagine that is to punish the minoritythat are coding more -214's and try to gain favor with those billingmostly -213's. Quite a clever chess move, it would seem.CB> > > v\:* {behavior:url(#default#VML);} o\:*{behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);} Question for thosein areas where this is taking place. Is the payment closer to what youwould get for a 99213 or a 99214 (given that 99215s are also blendedin)? I mean, if the insurances are paying only 99213 prices, then theyare

effectively downcoding, but if they are paying higher than that, Iwould guess some dysfunctional practices that run everyone out with a99213 code would stand to make money. So although it encourages evenmore quantity over quality, I would guess not all practices would belosing out on this. > > > Blending of payments> > I haven't followed recent posts, so maybe this has already been>

addressed. This weblink goes to an AAFP article talking about Cigna's> policy (and Anthem in Ohio) of making -213 -214 and -215 payments> "blended" in one. Yet another effort to up the insurance profits and> stick it to the physician once again--and who gets most affected by> this--the office visit leveraged family physician (versus procedure> specialists). I think someone's trying to turn off the ventilator on> the future of primary care.> > http://www.aafp.org/x42512.xml> > CB> > > > > > > >