MCMS Physician Fall 2017 - 19
mon t m e d s o c .c om
2017 Legislative Priorities
PAMED Continues to Oppose
IBC Modifier 25 Payment Policy
he Pennsylvania Medical Society (PAMED) continues to
advocate on behalf of physicians in strong opposition to
a new Independence Blue Cross's (IBC) payment policy,
which is reducing physician reimbursement when Modifier 25 is
When an E&M service is provided on the same day as a
procedure with a 0-day or 10-day global period, IBC is reducing
reimbursement for the E&M by 50 percent. It is also reducing
reimbursement for the E&M when it is provided on the same day
as a preventive service.
PAMED has sent several letters to IBC, and held a conference
call prior to the policy change effective date to strongly urge IBC
to rescind, or at the very least, delay, the new policy. IBC has
refused to do so. Essentially, they are penalizing physicians who are
efficiently meeting the multiple medical needs of their patients.
PAMED sent a follow-up letter to IBC on Aug. 3, 2017. In the
letter to IBC, we asked IBC to provide:
* A list of other carriers who have implemented similar policies.
While IBC has provided this list, none of the carriers are
local and this type of policy is not common or widespread.
In fact, there are less than 10 carriers in the U.S. who have
implemented similar policies.
one with ten to fifteen practices that will be affected by the
policy change to discuss the policy and its potential financial
IBC has agreed to participate in such meetings, and PAMED
is in the process of selecting a vendor to assist with screening
practices to assess their suitability and proper usage of Modifier 25,
prior to PAMED arranging a meeting between the practice and
PAMED is continuing to explore other avenues in opposing
IBC's policy on behalf of its members.
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* Various government reports that it claims support the need
for this policy. While IBC has provided these reports, one is a
report from the OIG that is more than 10 years old, another
is a report from the New York Comptroller's Office which
has no bearing to Pennsylvania practices, and a few anecdotal
instances of inappropriate use.
* Benchmark utilization data comparisons justifying the change
in policy - IBC has not yet provided this data.
* In the letter, PAMED also requested that IBC meet one-on-
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M C M S P H Y S I C I A N 19 F A L L 2 0 1 7
Table of Contents for the Digital Edition of MCMS Physician Fall 2017
MCMS Physician Fall 2017 - 1
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