MSNJ REACHES SETTLMENT AGREEMENT WITH HORIZON
In response to MSNJ’s compliance dispute and complaints from many physicians, Horizon issued two revised payment policies, the first on March 18 concerning
Modifier 25, and the second on May 14 concerning
Modifier 59. Horizon’s revised payment policy on modifer 25 allows payment on one E/M code at 100% and on a second e&m code at 50%. Horizon’s revised payment policy on modifier 59 allows payment of services appropriately appended with modifier 59 at 100%. The revised policies are a significant improvement over the February payment announcement.
Horizon recently responded in full to MSNJ’s pending compliance dispute. The Horizon response, coupled with the two revised payment policies, is responsive to our concerns and consistent with industry practice and coding guidance. Yet to be resolved is how Horizon will select the E/M code for payment at 100%. MSNJ will further explore that issue through the compliance dispute process. We will also coordinate our response with another pending compliance dispute, individually filed, on the modifier 25 and 59 issues.
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