Prominent health insurers are putting up roadblocks to swift reimbursement for postoperative pain blocks, according to Anesthesia Business Consultants President and CEO Tony Mira.
Three things to know:
1. Two national payers have implemented a pre-screening edit of the -59 modifier, making it increasingly difficult for providers to get payment for postoperative pain blocks.
2. The payers are routinely requesting additional information before processing services, and still may not pay after receiving the additional documentation.
3. Other payers are following their lead. Anthem of Virginia announced it will update its audit process for claims with modifiers used to bypass claim edits. Those claims will be reviewed through a "pre-payment clinical validation review process."