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  • 03.6.18

    AMIC Applauds Anthem for Addressing Provider Feedback in Change to Reimbursement Policy

    Encourages the Roll Back of Additional Policies Related to Denials of Site of Service Advanced Imaging and Retrospective Coverage Denials

    Washington, D.C. – The Access to Medical Imaging Coalition (AMIC) today applauded Anthem for deciding not to proceed with its reimbursement policy relating to physician use of payment modifier 25 following feedback from several medical societies. In light of the decision, AMIC encouraged Anthem to revisit its additional policies that adversely impact providers. Specifically, AMIC expressed concern with Anthem’s policies related to outpatient imaging and emergency department use, which would jeopardize patient care.

    “We are encouraged by Anthem’s decision and hope that the company will continue the dialogue with the physician community to address concerns with additional policies and guidelines that would disrupt the continuum of care delivery,” said Tim Trysla, executive director of AMIC. “We are especially concerned with two of Anthem’s policies — one that directs patients who need an MRI or CT away from hospital-based outpatient imaging services and another that retroactively denies coverage for emergency room services deemed non-emergent.”

    Anthem’s policy limiting the availability of imaging services largely denies imaging performed in the hospital outpatient setting. This can disrupt the ordering physicians’ relationships with radiology practices and can dramatically reduce patients’ options as to where imaging is performed. Additionally, Anthem also initiated retrospective reviews of all services, including scans, administered in the emergency department in select states. If these services are deemed non-emergent, Anthem will retrospectively deny coverage and force the patient to cover the expenses. Such a policy unfairly shifts the responsibility for determining the difference between an emergent or non-emergent situation to the patient.

    AMIC’s members include physicians, patient organizations, and medical imaging equipment manufacturers who have long stressed the importance of identifying policies that safeguard patient access to appropriate medical imaging services.

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    The Access to Medical Imaging Coalition represents physicians, medical providers, and patient organizations throughout the U.S. It also includes health technology firms that manufacture imaging equipment and supplies and that employ tens of thousands of workers. Thus, AMIC represents those who develop medical imaging technologies, those who apply it, and those who benefit from it.

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