MSSNY Member Criticizes New Excellus Reimbursement Policy
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In a letter to the editor of the Syracuse (NY) Post-Standard (10/15), MSSNY member Dr. Brian Raphael discusses Modifier 25, a new Excellus BlueCross BlueShield reimbursement policy that “applies when a patient receives a medically necessary office visit and a separate, medically necessary procedure on the same day.” The “new policy reduces reimbursement for the lower-cost service when both are provided together.” Dr. Raphael writes that “Excellus says the policy is not intended to encourage separate visits,” but “our concern is the unintended consequence: reducing reimbursement for providing these services together could discourage same-day care that saves patients another appointment, time away from work or family, and treatment delays. We aren’t alone in raising concerns. The American Medical Association (AMA), NYS Society of Dermatology and Dermatologic Surgery, Medical Society of the State of New York and American Academy of Dermatology have met with Excellus.” Dr. Raphael adds, “We urge Excellus to work with physicians toward a solution that protects efficient patient care and preserves access to independent medicine in Central New York.”
MSSNY has shared this media coverage with the NY Department of Financial Services to urge that they step in to prevent this cut from moving forward. Physicians can assist in this effort by sending a letter to their legislators, Oppose Health Insurer Cuts to Same-Day Care (Modifier 25) for Patients, urging that they support legislation to prohibit all health insurers from implementing these types of cuts.
