NPR highlights DOs practicing in rural areas, Cigna further delays implementing reimbursement policy following AOA advocacy

The osteopathic profession continues making strides thanks to the many wonderful DOs and osteopathic medical students who excel in their roles. Following are some recent professional recognitions and accomplishments the profession is currently celebrating.

AOA Trustee and other DOs highlighted in NPR article about osteopathic physicians helping to bridge the gaps in access to rural health care

In many rural areas across the country, there is insufficient access to primary care physicians. This is, in part, due to many health care professionals opting to work in cities, where more high-paying specialty positions are available. However, there is a growing trend of DOs choosing to fill in the gaps in these small towns.

Since 2000, the number of osteopathic medical schools in the United States has more than doubled, as reported in a recent article by NPR. Many of these new schools are located in rural states, such as Idaho, Oklahoma and Arkansas. School location and teaching methods help explain why many graduates gravitate towards jobs in smaller towns.

Although DOs are still the minority among U.S. physicians, their ranks have steadily grown over the past few decades. As of 2023, the AOA represents over 178,000 osteopathic physicians and medical students.

To read more about the impact that DOs are having in rural America, read the NPR article “With few MDs practicing in rural areas, a different type of doctor is filling the gap,” which features an in-depth discussion with AOA Trustee Kevin de Regnier, DO, and an insider look into his private family practice in Winterset, Iowa.

Cigna announces further delay of reimbursement policy

Following advocacy efforts by the AOA/AOIA Physician Services Team, the American Medical Association and impacted specialties, Cigna announced that it plans to delay the implementation of a reimbursement policy that requires the submission of office notes with claims submitted with evaluation and management (E/M) codes 99212-99215 and Modifier 25 when a minor procedure is billed.

The reimbursement policy was scheduled to take effect on Aug. 13, 2022, and again on May 25, 2023. While Cigna remains committed to ensuring appropriate usage and reporting of Modifier 25, they have acknowledged that the policy does not comply with clean claims laws in 24 states. As of the time of writing, Cigna has not provided a new implementation date for the policy.

In many cases, reimbursement for E/M services on the same day a procedure is also performed by the same physician is included in the payment for the procedure. The E/M service code should not be separately reported. In some cases, and often for osteopathic manipulative treatment (OMT), significant E/M services are rendered that are separately identifiable from the procedure performed. These separate E/M services must be substantial enough to require a separate service, i.e., address a new, distinct or exacerbated problem.

Modifier 25 was created to identify these circumstances and to indicate that it is appropriate to separately report the E/M services in addition to the performed procedure. Modifier 25 is used to show that, on the day a procedure was performed, the patient’s condition required a significant and separately identifiable E/M service above and beyond other services provided.

The necessity for independent E/M services may be prompted by a complaint, symptom, condition, problem or circumstance that may or may not be related to the performed procedure. Thus, it is not necessary to present diagnoses different from those related to the procedure to report a significant and separately identifiable E/M service.

When a procedure is performed as a follow-up service or is the primary reason for a patient encounter, reporting E/M services is only warranted if a new condition occurs or the patient’s condition has changed substantially, necessitating an overall reassessment.

More detailed information regarding Modifier 25 is available online, and more resources regarding private payer advocacy are available on the AOA’s webpage dedicated to supporting physicians and streamlining the payment of claims, while improving outcomes for patients.