Both Medicare and commercial insurers have long paid physicians different amounts for each of the five levels of office visits. Now Anthem Blue Cross and Blue Shield Ohio, a subsidiary of WellPoint, the nation's largest insurer, has thrown that system into question by blending payments for level 3 and 4 visit codes into a single rate. This new policy, which became effective in Cincinnati, Dayton, and the rest of southern Ohio last November, greatly concerns physicians and medical leaders on both the local and national level.
"Common sense would tell us that if you're using codes that have been carefully developed over the years to reflect a level of service, you should be reimbursed more for more service," says ob/gyn Molly A. Katz, president of the Ohio State Medical Association (OSMA).
OSMA says the reimbursement changes—which raise payments for level 3 visits and lower those for level 4 visits—are tantamount to downcoding. While Anthem has predicted that only 25 percent of physicians will get paid less and that nearly half will receive more overall, the prevailing view among physicians is that they'll be losers. In fact, Group Health Associates, a 102-doctor practice that's the largest in Cincinnati, could lose several hundred thousand dollars a year in revenue, says FP Michael J. Barber, the group's CEO.
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