September 23, 2013
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement Practice Management
In May, Cigna began a five phase roll out of new reimbursement rates and contract terms to approximately 5,000 Southern California providers who are currently operating under older versions of Cigna contracts. According to the notice, the updates reflect not only changes to the fee schedule, but also changes to contract language to ensure compliance with federal and state regulatory requirements. The next phase is set for a mail date of early October with a January 1, 2014, effective date.
Cigna has advised the California Medical Association (CMA) that it is migrating physicians currently tied to its 2003 fee schedule to its updated 2012 standard fee schedule, which incorporates new codes and coding updates.
The notice provides 90 days’ advance notice of the change and instructs physicians who do not agree to the changes to send written notice of their objection within 20 business days of receipt to Cigna (Attn: Contracting Department #300, 400 North Brand Boulevard, Glendale CA 91203). Physicians who do so will receive a call from Cigna to discuss further. If an agreement cannot be reached, the contract may be terminated.
CMA has received calls from practices expressing concerns that the 20 business day deadline is too short. Additionally, practices have expressed concern that the fee schedule included with the notice is not a complete fee schedule, reflecting only the top 100 billed CPT codes. Some practices reported that they contacted the Cigna Customer Service Center to obtain the full fee schedule, without success.
CMA brought these concerns to Cigna's attention. In response, Cigna provided the following clarifications:
- 20 business day deadline – The notice states physicians must notify Cigna within 20 business days of receipt if they do not agree with the changes. However, to allow time for the physician to evaluate the changes, the insurer will accept written notices from physicians who do not agree to the changes up until 15 days prior to the effective date.
- Access to the full and complete fee schedule – CMA has communicated the difficulties some physicians have experienced in obtaining the new fee schedule from Cigna. In response, Cigna has provided additional education to its staff to ensure that requests for the fee schedule are complied with in a timely manner. Physicians can call Cigna at (800) 882-4462 and request the new fee schedule. Cigna has advised that it will send the full fee schedule via email in excel format. Practices who continue to experience difficulties obtaining the fee schedule are encouraged to call CMA at (888) 401-5911.
Affected physicians are encouraged to carefully review all proposed amendments to payor contracts. CMA has develop a simple financial impact worksheet to help physicians analyze proposed fee schedules and assess the impact any fee schedule change may have based on the practices’ commonly billed CPT Codes. This worksheet is available free to CMA members on the Billing Assistance page.
Additionally, to help physicians understand their rights when it comes to payor contract amendments, CMA has published, Contract Amendments: An Action Guide for Physicians, which walks through a physician’s options when a payor makes a material change to a contract.
Questions about the contract can be directed to the Cigna Customer Service Center at (800) 882-4462.
Contact: CMA’s reimbursement helpline (888) 401-5911 or firstname.lastname@example.org.