Humana Announces Revised Payment Policy
As a result of dialogue with the ACR, Humana announced in a letter sent to their network physicians this week, that effective April 24, 2006, the company revised its "contiguous body part" multiple-procedure policy for imaging services performed on the same day to be consistent with the Centers for Medicare and Medicaid Services (CMS). Therefore, Humana will reimburse 100% of the technical component (TC) for the first scan and 75% for the TC of the second and subsequent scans. No reductions will be applied to the professional component (PC). Following CMS, beginning January 1, 2007, Humana intends to phase in a 50 percent reduction of the TC for the second and subsequent scans.
In September 2005, Humana implemented a policy which paid 100 percent of the TC and PC for the first scan with no reimbursement for the TC or PC for the second and subsequent scans. This policy was implemented without written notice to providers. The ACR became aware of these denials through member feedback and initiated discussions with Humana, which led to the decision of the company to conform with CMS. Dialogue continues in an effort to seek retroactive payment for services denied between September and April. In addition, the ACR continues to have dialogue with CMS and private payers regarding the 50 percent contiguous body part reductions.
Click Here to view a copy of the letter sent by Humana to its network providers.
Click Here to view the 11 families of procedures affected by these changes mentioned in the Humana letter.
Please feel free to contact Kathryn Keysor in the Economics and Health Policy Department, at (800) 227-5463, extension 4950, or via e-mail to kkeysor@acr.org if you have any questions.
