UnitedHealthcare issued a policy update on July 1 that will cut reimbursements for certified registered nurse anesthetists by 15%.
Here are five things to know about the policy shift:
1. Effective Oct. 1, a 15% reduction in reimbursement will be applied to claims for anesthesia services rendered by CRNAs practicing independently. For claims billed under the QZ modifier — those rendered by CRNAs — the CRNA will now receive 85% of the allowable.
2. CRNAs in Arkansas, California, Colorado, Hawaii, Massachusetts, New Hampshire and Wyoming are exempt from the new reduction.
3. Units reflecting physical status modifiers P3, P4 and P5 will no longer be included in UHC’s anesthesia reimbursement calculations.
4. UHC’s reimbursement calculations will also no longer include units for qualifying circumstances codes 99100, 99116, 99135 and 99140. According to the update, CMS has assigned these codes a payment status B in the national physician fee schedule and considers them “bundled services,” not separately reimbursed.
5. The policy update has sparked criticism from American Association of Nurse Anesthesiology, who said the shift could have significant consequences for healthcare cost and access.
“This is yet another attempt to discriminate against CRNAs by offering less compensation for their skills, expertise and time,” said AANA President Jan Setnor, MSN, CRNA, in a statement shared with Becker’s. “All anesthesia providers are trained in and use the exact same techniques to administer anesthesia, yet no other providers face the same cut – United Healthcare is blatantly targeting CRNAs, based on their licensure alone. This action is unlawful, unacceptable and unconscionable, particularly as our nation continues to face a shortage of anesthesia providers.”
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