Effective 08/13/22, Cigna is pulling sooooooome shiiiiiiiiiiiit as it pertains to Modifier 25. Every claim with Mod 25 will require medical records for review. EVERY. SINGLE. CLAIM.
“How the heck can they feasibly review all those records in a timely fashion,” you say?
I have created a short video to outline how I expect this will play out. Please enjoy…
Yes, Cigna is planning to systemically and repeatedly deny all E/M (“evaluation and management” AKA consult/office visit codes) with a Mod 25. That means that every time any MD ever sees a patient and renders a distinct/separate procedure…the claim is going to experience, at minimum, a 30 day delay for reimbursement. Probably 60 (e.g., “oops we never got your records, pls send again). Maybe 90 (e.g., “we received your records, but we’re using the record receipt date as if you didn’t send the claim prior and now we’re going to deny for timely filing).
Some folks are invariably going to not be able to follow up on every claim after every BS denial… and not get paid… and guess where that money goes?
IN THE POCKET OF THE HIGHEST PAID INSURANCE EXEC’S POCKET OVER THE PAST 10 YEARS!! This is literally madness.
Want to read the fine print…be my guest…right below.
Don’t have the time or patience to deal with this garbage? Neither do we, but it’s our job. We meet Cigna’s stab with our parry and leverage DocVocate, an automated appeal tool, to embed our custom appeal template specific to this BS denial. We also set an automation so that when we get a denial, from Cigna, with Mod 25, the system tees up and pre-populates the appeal…so we just press send. Automated denial…meet automated appeal.