UnitedHealthcare, a payer with which many family physicians have contracts, has agreed to revise a payment policy that the Academy has argued for months is unfair to physicians.
UnitedHealthcare Takes 'First Step' in Revising Payment Policy
By Sheri Porter
5/9/2006
In an April 26 letter, Richard Justman, M.D., UHC's national medical director, informed AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif., that UHC will pay physicians separately for "acute care services provided during a preventive medicine visit."
However, the Academy considers UHC's policy revision -- to be implemented during the first quarter of 2007 -- only a partial victory for family physicians because UHC is not offering full payment for both services provided by the physician.
In the letter, Justman explained UHC's decision regarding partial payment for the evaluation and management portion of a visit: "Because much of the work encompassed in the respective E/M and preventive medicine codes is duplicative, our reimbursement of the acute care (or E/M) service will be at 50 percent of the fee schedule rate," he said.
After reviewing the letter, Frank said that she appreciated UHC's attempt to align its payment policy with current CPT guidelines on which the Academy has based its argument for full payment for both services. She said UHC's revised policy of 50 percent payment for acute care services provided during a preventive care visit is "a positive first step."
"The debate is not over on this issue," said Frank. "I hope that, after further review, UHC will recognize the benefit to both patients and physicians of providing full, not partial, payment for a separate and significant acute service."
Frank said that because of the wide scope of services offered by family physicians, many preventive care visits turn out to be "much more than routine."
When a patient comes in for an age-related preventive screening, "it's not in the patient's best interest -- nor is it respectful of a patient's time -- to separate care of an acute or chronic health problem and require the patient to make a another appointment because of payer payment schemes," she said.
From the physician's perspective, said Frank, "it's not good medicine to schedule another visit unnecessarily, and it's not good business to provide complex care of an acute or chronic problem during a preventive visit only to receive less than full payment for that care."
Last fall, the Academy called on 44 health plans, including UHC, to stop bundling payment codes for patients' preventive visits with those for problem-oriented E/M services when both services occurred on the same day. In February, Aetna began paying physicians 100 percent of the fee schedule rate for acute care services provided at a preventive care visit.
However, the Academy considers UHC's policy revision -- to be implemented during the first quarter of 2007 -- only a partial victory for family physicians because UHC is not offering full payment for both services provided by the physician.
In the letter, Justman explained UHC's decision regarding partial payment for the evaluation and management portion of a visit: "Because much of the work encompassed in the respective E/M and preventive medicine codes is duplicative, our reimbursement of the acute care (or E/M) service will be at 50 percent of the fee schedule rate," he said.
After reviewing the letter, Frank said that she appreciated UHC's attempt to align its payment policy with current CPT guidelines on which the Academy has based its argument for full payment for both services. She said UHC's revised policy of 50 percent payment for acute care services provided during a preventive care visit is "a positive first step."
"The debate is not over on this issue," said Frank. "I hope that, after further review, UHC will recognize the benefit to both patients and physicians of providing full, not partial, payment for a separate and significant acute service."
Frank said that because of the wide scope of services offered by family physicians, many preventive care visits turn out to be "much more than routine."
When a patient comes in for an age-related preventive screening, "it's not in the patient's best interest -- nor is it respectful of a patient's time -- to separate care of an acute or chronic health problem and require the patient to make a another appointment because of payer payment schemes," she said.
From the physician's perspective, said Frank, "it's not good medicine to schedule another visit unnecessarily, and it's not good business to provide complex care of an acute or chronic problem during a preventive visit only to receive less than full payment for that care."
Last fall, the Academy called on 44 health plans, including UHC, to stop bundling payment codes for patients' preventive visits with those for problem-oriented E/M services when both services occurred on the same day. In February, Aetna began paying physicians 100 percent of the fee schedule rate for acute care services provided at a preventive care visit.
