Medicare Compliance & Reimbursement

If you see patients who are covered by Anthem Blue Cross Blue Shield, it's a good time to brush up on that payer's latest imaging policy, which could negatively impact your pay.

This past summer, Anthem began implementing a new policy that aims to stop paying for MRIs and CT scans performed in hospital-owned outpatient facilities. Instead, Anthem directs these patients to go to independent imaging centers for such scans and tests. The payer expects to have this policy in place across all of its coverage areas by March 2018.

Anthem points to a three-pronged reason for these changes: Improving the patient experience of care, boosting health across populations, and cutting the per-capita cost of health care. "Anthem's primary concern is to provide access to quality and safe health care for our members. We are also committed to reducing overall medical cost where possible when the safety of the member is not put at risk," the company said in an FAQ document about the change.

The change is likely to affect hospital or freestanding emergency departments (EDs), because they could lose pay for the actual tests performed. The update could also impact availability for advanced imaging in the ED setting, and may cause complaints for emergency physicians after the ED performs testing that prompts high charges which later become the patient's responsibility.

Resource: To read Anthem's announcement about the changes, visit www11.anthem.com/provider/in/f4/s0/t0/pw_g303738.pdf.