Some Insurers Indicate No Change in Reimbursement for Consultation Services in New Year

December 14, 2009

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During initial talks with the Academy, large national private insurance companies revealed that they do not have planned changes to their reimbursement scheme for E/M services as of January 1, and that —unlike the Centers for Medicare and Medicaid Services (CMS)—they will continue to reimburse providers for consultation service codes at contracted rates to start 2010.

Private insurers are acutely aware of the CMS adjustments: many have convened special teams to develop an action plan or plans around the changes. In the event that a private insurer would move forward with changes in reimbursement policy for consultation services, the plans that the Academy has discussed will acknowledge a requirement of 30-day (in some cases even a 90-day) notice period to inform providers of the changes.

Implementation dates and details about any changes would be posted to the provider section of the insurer’s website. The insurers indicated that appeals, if received, would be handled according to the standard provider appeal process for any services that are denied. Appeal processes are also typically outlined on the provider section of the website.