decisionhealth Newsletters, Coder Pink Sheets - 2006 Issue 6 (June)
Aetna agrees to change its -25 payment policy
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Article Overview
This piece covers an Aetna claims-payment policy change tied to modifier -25, following a lawsuit settlement involving state medical societies. It is relevant to practices that bill E/M services and want to understand the affected date span, the categories of procedures involved, and the payer’s interim handling of denials while system edits are updated.
Why This Topic Matters
Practices with Aetna in their payer mix may need to review past and current E/M claims impacted by this policy change, especially while automated edits and manual reprocessing are being updated.
What You Will Learn
- What the article says about Aetna’s modifier-25 payment policy change
- Which broad types of services were included in the affected claim review
- How the article characterizes the timing of claim reprocessing and system edits
- What payer and professional-society actions prompted the policy change
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Practice managers
- Compliance staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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