Payment: Contracting, Coding, Bundling and Claim Denials
Our Stance
It is the position of the AAFP that every reasonable effort should be made to devise a payment system that:
- emphasizes increased payment for cognitive skills relative to procedural skills;
- acknowledges and pays for case management services as necessary for the provision of continuous, comprehensive patient care; and
- encourages and pays for preventive care. Read the full policy on payment.
Working for You
AAFP hears your concerns about payment. Our Private Sector Advocacy team works directly with payers to help ensure that you're compensated fairly for the care you deliver as well as provides you tools to most effectively engage private payers, such as the AAFP Contracting Guide (12-page Members Only PDF; About PDFs) and antitrust advocacy to level the playing field for physicians when contracting with private payers.
We're in constant contact with private payers, urging them to:
We're in constant contact with private payers, urging them to:
- Stop bundling same-day acute and preventive services.
- Pay adequately for immunizations and their administration.
- Cover and pay for non-face-to-face services.
- Rescind payment policies that downcode and blend E/M services.
- Accept Medicare's new relative value units, or RVUs, which encourage increased physician/patient communication.
- Use a single conversion factor in their physician payment formula.
- Cease any family medicine-specific scope of services limitations (e.g. non-payment for delivered services, disallowing ordering certain tests/services, etc.).
What We're Working On
