In a recent development, Blue Cross Blue Shield (BCBS) in Texas, Oklahoma, Illinois, and New Mexico (Health Care Service Corporation, HCSC) and Aetna have announced that they will no longer reimburse anesthesia providers for Physical Status Modifiers (PSMs), citing CMS payment policies as the reason. While BCBS has delayed the implementation of this policy to allow time for stakeholder input, Aetna is set to proceed with this change starting on July 15, 2024. This significant change in reimbursement policy has raised numerous concerns among anesthesia providers, who rely on these modifiers to accurately represent the complexity and risk of their services.
Financial Impact
The foremost challenge arising from HCSC and Aetna’s decision is the financial impact on anesthesia providers. PSMs are critical in determining the complexity and associated risks of anesthesia services. By eliminating reimbursement for these modifiers, anesthesia providers face a substantial reduction in their overall reimbursement. This reduction can significantly affect the financial sustainability of their practices, especially for those who frequently handle high-risk patients. The lack of compensation for the additional care required for these patients can lead to financial strain, potentially affecting the financial sustainability of their practices and the quality of care provided.
Inconsistent Reimbursement Policies
Another major issue is the inconsistency in reimbursement policies across different commercial payers. Anesthesia providers often work with multiple insurance companies, each with its own set of guidelines and policies. The decision by HCSC and Aetna to discontinue PSM reimbursement exacerbates the growing inconsistency in these policies. This lack of uniformity creates a challenging landscape for providers, who must navigate through complex medical billing and reimbursement processes. It can lead to increased administrative burdens and potential revenue loss due to denied claims or reduced payments.
Navigating Policy Changes
Ventra Health offers crucial support to anesthesia practices navigating these and other policy changes that negatively impact their bottom line. Ventra can review current agreements and advocate for budget-neutral rate adjustments to offset the reduction in reimbursement resulting from these policy changes. This proactive approach is essential in mitigating the financial impact and ensuring that anesthesia providers can continue to offer high-quality care without financial constraints.
Please contact us for assistance with these policy changes or any other payer-related issues. Together we can overcome the challenges these policy changes have on your practice.
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