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MEDTECH The policy applies to E/M CPT codes 99212, 99213, 99214, and 99215, and modifier 25.
Cigna Healthcare’s recent changes to its payment policy, mandating submission of office notes for minor procedure claims, has sparked a wave of concern amongst oncologists and other providers. This move, they fear, may overload Cigna’s electronic claims submission system, leading to rejected claims and other complications, while potentially impacting the quality of patient care.
Key Points:
- Cigna’s new policy requires submission of office notes with all minor procedure claims.
- Critics fear this policy could overload Cigna’s electronic claims submission system, leading to rejected claims.
- Concerns exist about potential HIPAA violations due to uncertainty about the security of the provided email or fax number for document submission.
- There’s worry the policy may discourage simultaneous performance of minor procedures and E/M services, potentially delaying patient care.
Additional Points:
- The American Medical Association and more than 100 medical organizations have expressed concerns about this policy.
- The policy was initially announced in 2022 but was paused after pushback. It was reintroduced in March 2023 and took effect on May 25, 2023.
- Critics question the reasoning behind the policy change and its potential encouragement of over-documentation and “note bloat.”
Conclusion:
- The new Cigna policy, if left unchanged, could pose substantial administrative and care delivery challenges to healthcare providers, potentially impacting patient care and setting a precedent for other insurers.
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“Cigna should be making it easier for doctors to see [and treat] their patients, not more difficult.”
Suzan Hauptman
Compliance and Privacy Officer and Assistant Vice President
Cancer Treatment Centers of America, part of the City of Hope
