MOA Members Experiencing Frequent OMT/Mod-25 Denials
(Update: Sept. 20th, 2019)
The Maine Osteopathic Association’s Medical Economics Committee (formerly Payor/Payee Committee) has received a number of recent calls and emails from members regarding concerns about osteopathic manipulative treatment (OMT) payment policy.
Complaints have largely focused on the issue of Evaluation/ Management codes billed on the same date of service with OMT codes using Modifier 25. Anthem & Aetna have announced new clinical validation policies which are believed to be one cause of the large volume of denials members are experiencing. The MOA has secured contacts and held meetings with carriers including Harvard Pilgrim, Anthem & Aetna to discuss these denials on behalf of our members and to share information about standard OMT coding conventions. Many of these conversations are ongoing (meetings with Anthem and Aetna in particular have been held in the last 30 days and follow-ups are in the process of being scheduled). We urge members to reach out to the MOA office at 207-623-1101 for details on these issues and for more detailed information.
The AOA is also actively involved in conversations with Anthem about their new clinical validation policy, which affects claims appended with modifiers 25, 57, and 59. For more detail on that policy, see that AOA's statement here.
We know that members are concerned about the volume of denials they are receiving. We are actively educating and advocating for fair and appropriate reimbursement. We are making slow progress.
We encourage members to review all denied claims. Be sure to follow instructions regarding re-submitting the claim and providing documentation upon appeal. We would also remind you to keep detailed records. We understand that these changes in payment policy create additional administrative burdens and can also negatively impact patient care.
The MOA Medical Economic Committee, co-chaired by Stephanie Collins, DO & Kiran Mangalam, DO continues to engage in our meetings with insurers and expects to meet & develop an action plan to further involve concerned members in the coming weeks. If you have concerns about medical claims being denied, feel free to complete the MOA Hassle Factor Form and/or call the MOA office at 207-623-1101. This information helps us to track trends and changes in payment policy.
AOA Members: You can also contact the AOA Physician Services team for assistance by email at email@example.com
(08/09/19) Notice of Staff Change at the MOA
MOA Part-time staff member Lynne McKenney has accepted a new position outside of the organization. Her last day in the MOA office was August 2nd. We thank her for her service to the MOA and wish her well in her new position! She will be missed.