Two major national payers, UnitedHealthcare and Cigna, recently switched or delayed planned policies due to pushback from industry leaders, patients and physicians.
UnitedHealthcare
In March, UnitedHealthcare announced plans to implement new prior authorization requirements for certain endoscopy procedures.
The plan was met with pushback by three major gastrointestinal organizations and physicians, even though UnitedHealthcare claimed that the new policy would improve patient safety.
The night before the policy was supposed to be enacted, UnitedHealthcare rescinded the change, instead implementing an advanced notification program. Practices that comply with the requirements could be eligible for a new "gold card" system.
The new system has also been met with blowback from physicians and GI societies.
Cigna
Cigna delayed the implementation of a policy that would require the submission of medical records when using modifier 25 for all evaluation and management claims billed with CPT codes 99212-99215 and a minor procedure.
The policy was set to go into effect May 25. Cigna plans to continue reviewing the plan for future implementation.
More than 100 physician groups requested that Cigna reconsider the policy, claiming it would add administrative costs and burdens.