Aetna will correct erroneously low payments made to physicians for G2211 claims following Texas Medical Association advocacy during a meeting with the payer Aug. 2.
Previously, Aetna was paying only one cent to physicians for claims appended with the Medicare add-on code for complex care. Aetna representatives confirmed during its meeting with TMA that its payment system was fixed July 15 to pay the full allowable amount to physicians for G2211 claims.
TMA billing and coding staff also say Aetna has begun to correct payment disparities, with a retroactive date of Jan. 1, and the health plan aims to recompense physicians per claim instead of in a lump sum. Physicians do not have to take action to receive updated G2211 payments.
The Aetna meeting is part of a regular series of discussions the association holds with major payers throughout the year.
“TMA’s relationship [with payers] is important because [health plans] do not usually understand how incorrect payment affects physicians unless they hear it directly from us,” said Tina Philip, DO, a member of TMA’s Council on Socioeconomics. “In this case, Aetna ended up being receptive to our [feedback].”
The Round Rock family medicine physician added that working with health plans to resolve concerns regarding incorrect G2211 payments has been a “constant battle” for her practice. She attended TMA’s meeting with Aetna after receiving incorrect payments from the insurer.
“Payment interruptions seem to stem from both a lack of communication from Aetna and … that they were slow to update their fee schedule with the correct allowable amounts,” Dr. Philip said. “Something that should be helping physicians is now causing more headaches.”
However, Dr. Philip adds that “thanks to TMA, G2211 issues are hopefully on the way to getting resolved.”
In the meantime, TMA billing and coding staff generally recommend practices to continue to file G2211 codes as usual and maintain detailed records of all communication with Aetna. Aetna has indicated it will continue to pay G2211 claims for Medicare Advantage, but not for commercial or Medicaid products.
TMA billing and coding staff generally recommend physicians use G2211 when:
- They have assumed or intend to assume responsibility for the patient’s ongoing medical care; and
- Their visits with the patient are routine or time-limited. For example, a physician who sees a patient for an acute concern should not report G2211 if they have not also assumed responsibility for the patient’s ongoing medical care or do not plan to take responsibility for subsequent medical care.
For more information on billing and coding, visit TMA’s comprehensive Physician Payment Resource Center.
NOTICE: This information is provided as general information on billing, coding, and reimbursement issues. This is not a substitute for the advice of an attorney. Although TMA has attempted to present materials that are accurate and useful, some material may be outdated and TMA shall not be liable to anyone for any inaccuracy, error or omission, regardless of cause, or for any damages resulting therefrom. Your specific facts may affect the general information provided. Certain links and attachments are maintained by third parties. TMA has no control over this information, or the goods or services provided by such third parties. TMA shall have no liability for any use or reliance of a user on the information provided by third parties.
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469