Horizon Site of Service Payment Policy Change effective December 1

    By: Melinda Martinson, Esq. on Dec 01, 2016

    MSNJ began evaluating the financial impact of Horizon’s announced payment policy change on site of service differentials when we learned of it in September. This included: conducting a survey of practices to determine if they were aware of Horizon’s policy; coordinating with the New Jersey Association of Ambulatory Surgery Centers; and, analyzing data and providing guidance to members on the possible RVU differentials specific to specialty. Once we determined that gastroenterologists might be the most negatively impacted by the new payment policy, we began a collaboration with the American College of Gastroenterology and shared our analysis.

    We voiced our objections to Horizon that information for practices to evaluate the impact of the policy was not available on their web site. In response to our objection, Horizon discovered that a web site refresh had caused the information not to be available. 

    While the web site issues were addressed, we continued to assert that web site notice of a unilateral contract amendment was not sufficient and that the necessary information was not consistently available.

    Our request to Horizon that it delay implementation of the payment policy until physicians receive adequate notice and an opportunity to evaluate the impact was denied.  MSNJ continues to uphold this objection and we also expressed our concerns to the Department of Banking & Insurance through formal letters, emails and teleconferences. We will keep members apprised of our progress on this issue with the Department, but we expect the Horizon policy to become effective today. Once physicians learn of the impact of the decreased payments, we suggest that complaints be made directly to the Department. In addition, please take our survey, so that we can keep a tally of the number of physicians who were not aware of the payment policy change.

    Released: December 1, 2016, 9:58 am
    Keywords: Announcements

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