AAFP Asks CIGNA to Rescind Unfair Payment Policy

Concerned about unfair physician payments stemming from a blended-rate payment policy, the Academy has formally asked CIGNA HealthCare to end the practice.

The request came in a Feb. 24 letter to the insurer's Northeast office, which covers Connecticut, New York and New Jersey. The American Academy of Neurology, American Academy of Pediatrics, American Association of Oral and Maxillofacial Surgeons, American College of Foot and Ankle Surgeons, and American College of Physicians joined AAFP in signing the letter.

"Paying a blended rate (an average of several CPT codes determined by the health plan) for Levels 3, 4 and 5 office visits contradicts the concept of a resource-based relative value scale upon which the Medicare rates are based," said the letter. Higher-level office visits cost more for a reason: Not only does the physician spend more time taking the patient's history and completing the medical exam, he or she performs at a higher level of decision making, continued the letter.

"Medicare, the largest payer in the United States, recognizes and pays more for the higher levels of office visits on this basis, and we believe CIGNA HealthCare should, too," said the letter.

The Academy pointed out that physicians are trained extensively in proper documentation and coding techniques and said that the blended rate "subverts coding and documentation education previously provided to physicians."

In addition, patients are taking increasingly complex health issues to their primary care physicians, said the letter. That fact -- plus increased use of electronic health record systems that prompt physicians with care alerts and assist with documentation and coding -- points to a continuing trend of higher-level office visits.

The letter suggested CIGNA HealthCare work with individual physicians the company thinks are coding inaccurately by reviewing their documentation and providing whatever coding education it deems necessary. CIGNA "should not compromise the correct coding of all physicians for the perceived problems of a minority of physicians," said the letter.

Some background on blended rates: CIGNA's blended-rate program began as a pilot program, and that program has since become official payment policy.

Anthem Southern Ohio notified its participating physicians last fall that new and established Levels 3 and 4 office visits would be blended into one payment. The Academy responded to that action with a Nov. 10 letter to Anthem protesting the policy. As a result, Ohio AFP leaders met with Anthem officials on Feb. 16 to discuss Anthem's blended-rate payment policy, and they are scheduled to meet with Anthem's national medical director in March.

The AAFP is not aware of any other health plans currently blending payment codes.