Anthem's blending: Controversial policy gives one fee for 99213 or 99214

Why This Topic Matters

The article helps readers understand a reimbursement policy issue that can affect practice revenue, documentation incentives, and payer-provider relations in primary care and pediatrics.

Article Sections

1. Policy change and provider reaction

   Introduces the reimbursement policy change and outlines concerns raised by pediatric practices and coding staff about its impact on E/M billing and documentation.

2. AAP and coder perspectives

   Summarizes comments from physician leaders and coding professionals regarding the policy, documentation expectations, and broader implications for office visit coding.

3. Anthem claims blended rate has meant more money for docs

   Presents the payer’s explanation for the policy, including its stated administrative purpose and general reimbursement effect in the affected region.

4. Other Insurers Fail to Comment

   Notes the responses, or lack of response, from other insurers and mentions how their approaches compare at a high level.

5. Ongoing dispute and next steps

   Describes continued opposition from pediatricians and references possible future changes or review of the policy.