Prospective Relief - Fair Payment Rules

     

    Just what do the Aetna, CIGNA, Health Net, and Anthem/WellPoint settlements in the physicians' national antiracketeering class action lawsuits mean for how physicians do business with these health plans in the future? Here's a side-by-side comparison of the billing, coding, and payment provisions of the four settlements and existing federal law.

    Here are the topics the comparison covers:

    • E&M Downcoding
    • Add On and Modifier -51 Exempt
    • Modifier -25
    • Supervision and Interpretation
    • Indented Codes
    • Modifier -59
    • Global Periods
    • Automatic Downcoding of Service Intensity
    • Annual Update of Modifier-51-Exempt Codes
    • Non-exclusive Listing of Modifiers

     

    For even more details, see:


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