What Cigna’s Fractionalized Time Units
Mean To Your Practice’s Bottom Line
Have Your Cigna Collections Dropped Since May?
For those of you who provide anesthesia to Cigna patients, you may have noticed a significant reduction in collections since May 1st.
This is due to the payer’s national policy change, which now recognizes anesthesia time in the form of fractionalized units, similar to Medicare. Unfortunately, most practices are unaware that this change occurred and that they are typically losing between $30-$40 a case.
Time Rounding: Then vs Now
Prior to May 1st of this year, Cigna rounded up anesthesia time units, once you were one minute into the next 15-minute interval.
For example, an anesthesia case that took 46 minutes to complete would be paid at 4 whole time units, since Cigna considered the 46th minute as constituting a full unit.
Now, however, that last minute is converted into a fraction of 0.1 time units, bringing your case value to 3.1 time units instead of 4.
Have an Existing Contract?
Technically, payers are permitted to change their payment policies whenever they choose. However, if you have an existing contract that specifies a particular unit rate, you can request an increase to offset the effect of this policy, even if you’re not up for renewal yet.
To do so, you’ll first need to assess your financial losses at the case level, by using your billing company’s data.
The following illustration is based on a fictitious Cigna commercial rate of $75/unit and a Cigna Exchange rate of $65/unit.
As shown by the sample analysis above, anesthesia practices who contract with Cigna may be making less now than they were before May 1st. To this effect, it’s recommended that all groups quantify the financial impact of this policy change and take appropriate action, as needed.
MSN Healthcare Solutions has the Billing, Financial Management and Managed Care Contracting expertise to assist your practice in this area. Interested parties are encouraged to contact Steve Collins at (970) 988-2654 or firstname.lastname@example.org.
Hal Nelson, CANPC
has 30 years experience on both the payer and RCM side, with a focus in Anesthesia. He formerly worked as a senior claims approver at United Healthcare, as well as a compliance officer for multiple national billing companies. He has also taught the CPC coding curriculum collegiately in Atlanta. His broad based experience ensures that MSN clients will have a resource for documentation and billing issues. His past speaking engagements include ASA, MGMA, Dartmouth, and Johns Hopkins.
This educational guide was prepared as a tool to provide education for documentation and coding. It is not intended to affect clinical treatment patterns. The material provided is for informational purposes only. Efforts have been made to ensure the information within this document was accurate on the date of distribution. Reimbursement policies vary from insurer to insurer and the policies of the same payer may vary within different U.S. regions. All policies should be verified to ensure compliance. CPT® codes, descriptions and other data are copyright of the American Medical Association (or such other date of publication of CPT®).All Rights Reserved. CPT® is a registered trademark of the American Medical Association. Proprietary and confidential document. All rights reserved. No part of this document may be reproduced or used in any manner without the written permission of MSN Healthcare Solutions, LLC.