Resolution 24: United Healthcare Corporate Reimbursement Policy

Introduced by:  Byron J. Hoffman, MD – Delegate, NC Chapter, American College of Physicians

Referred to:        Reference Committee No. 1 – Timothy M. Beittel, MD, Chair

WHEREAS, National Current Procedural Terminology (CPT) coding guidelines clearly address the additional work required for medically complex patients and the appropriate use of Modifier-25 when an abnormality or a pre-existing condition is addressed in the process of performing preventive and wellness examinations; and

WHEREAS, all Medicare plans and commercial insurance carriers with the exception of United Healthcare follow CPT guidelines and reimburse each code at 100% of their fee schedules; and

WHEREAS, the United States healthcare system is at a crossroads of technology and patient needs with primary care as a crucial component of medicine’s future as patients live longer and develop more complex medical conditions; and

WHEREAS, federal mandates require implementation of electronic health records and electronic prescribing capability at a staggering financial and physical cost; and

WHEREAS, in an effort to avoid compromising access to primary care for patients, The Primary Care Incentive Payment was established by the Affordable Care Act and signed into law on March 23, 2010, and The Centers for Medicare and Medicaid Services calculated and established the payment methodology; and 

WHEREAS, all Medicare plans with the exception of United Healthcare obey this law with quarterly payments equal to 10 percent of the amount paid for primary care services under the Medicare Physician Fee Schedule; therefore be it

RESOLVED, That the North Carolina Medical Society supports national CPT coding guidelines; and be it further  (policy)

RESOLVED, That the North Carolina Medical Society promote reversal of the United Healthcare corporate policy of discounting payment by 50% for Evaluation and Management procedures performed during Preventive Care and Wellness Exams; and be it further  (action)

RESOLVED, That the North Carolina Medical Society supports the primary care incentive payments signed into federal law on March 23, 2010.  (policy)

Fiscal Note:  Estimated additional budget impact:  $6,000.  Current resources will be allocated based on the priorities of the Society and the NCMS budget.

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