Practice Management Alert

Providers who contract with Horizon Blue Cross Blue Shield (BCBS) of New Jersey can expect a small reprieve on modifier payment cuts, according to a recent memo issued by Horizon.

In the memo, Richard Popiel, MD, MBA, vice president and chief medical officer of health affairs for Horizon BCBS, says "we are revising our modifier 25 approach so that when two E&M services are billed for the same patient, on the same date of service, we will consider the E&M service appended appropriately with modifier 25 at 50 percent of the applicable Horizon BCBSNJ fee schedule and consider the other E&M service at 100 percent of the applicable Horizon BCBSNJ fee schedule."

In a February 2010 memo, Horizon BCBS stated that they would be cutting reimbursement by half on many modifiers, regardless of the circumstances surrounding their use.

The move is merely a revision to Horizon's original policy, said Janet Palazzo, CPC, of Regional Otolaryngology in Cherry Hill, N.J. Palazzo had been in contact with a Horizon representative who clarified that the policy is "tax ID driven." That means that "if a patient sees two different physicians with different tax ID numbers, regardless of the type of visit, they will be paid at the full rate," Palazzo said.

Horizon BCBS will also likely reduce E/M payment with a 25 modifier when used with a procedure. This reversal is only when two E/Ms are performed on the same day such as preventative care and a sick care carve  out performed by primary care. Surgeons who perform minor procedures on the same day as an E/M are still going to be shorted on their E/M payments.