DecisionHealth, DecisionHealth - 2006 Issue 6 (June)
Aetna to pay for denied E/M codes before August 1
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Article Overview
This article covers an Aetna agreement tied to denied evaluation and management claims, temporary and longer-term claims-processing changes, and a review of payment policies by a physician-payer committee. It is relevant to coders, billing staff, practice managers, and physicians who handle payer denials, modifier usage, and appeals-related reimbursement issues. The article also notes broader policy areas under review by the payer, including bundling edits and other nonpayment determinations.
Why This Topic Matters
The topic matters because it describes a payer settlement that can affect reimbursement for previously denied claims and may influence how future claims are processed. It also signals potential policy changes that could affect common billing workflows and payer-specific denial management.
What You Will Learn
- The general scope of an Aetna settlement affecting denied evaluation and management claims
- How the article frames temporary versus longer-term claims-processing changes
- What broader payment-policy issues are being reviewed by a physician-payer committee
- Which kinds of claims and service categories are implicated at a high level
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physicians
- Revenue cycle professionals
- Compliance staff
Codes Discussed
Modifiers Discussed
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