NJAFP Fights Recent Horizon Changes to Payment on 25-modifier

As many of our members are aware, Horizon Blue Cross Blue Shield of New Jersey recently announced changes to the payment for claims submitted using the 25-modifier that will significantly and negatively impact family physicians and their patients.  In a letter to Horizon, which was shared with the Department of Banking and Insurance as well as with members of the legislature, NJAFP President Steve Nurkiewicz identified some of the consequences of this change, including the likelihood of two visits for patients who might have been treated in one, as well as instances where physicians will be paid more in certain cases for an examination than they would be for an examination followed by a therapeutic injection.  Dr. Nurkiewicz noted that family physicians historically care for their patients regardless of payment, but accurately suggested that these perverse incentives are completely counter to the principles of the Patient Centered Medical Home. We are hopeful that both our dialogue with Horizon, as well as our communication with regulatory agencies and lawmakers, will cause Horizon to rethink this misguided action. However, many members have asked if there is anything that they can do individually with regard to this situation.  Members so inclined can file a compliance dispute under the national class action settlement agreement at www.hmosettlements.com. Click on the Blue Cross Blue Shield link on the left, then locate the compliance dispute form link. If you file a complaint please copy the NJAFP by emailing mcocomplaints@njafp.org. It may also be helpful to read section 7 of the actual settlement agreement for additional guidance. The NJAFP will continue to update members as new information becomes available.  NJAFP awaits Horizon's response.