Anthem has published new reporting and reimbursement guidelines for the care of patients with morbid obesity. This new policy, effective April or May 2015 (depending on the state), recognizes the increased resources required to care for these patients with all primary diagnoses.
The physician must document the BMI in the medical record and specifically which additional treatments, monitors, therapies and caregivers were required due to the presence of morbid obesity. The policy allows for reimbursement of services that might otherwise be denied without the above documentation.
While it appears this policy is unique to Anthem, the new rules are an important step in recognizing the complexity in caring for patients with morbid obesity. This policy and accurate documentation represents another way surgeons can collaborate with their respective hospitals to support our comprehensive care programs that have resulted in unprecedented high quality outcomes.
The policy can be found by clicking the links below:
- For New York: http://www.empireblue.com/provider/noapplication/f5/s1/t2/pw_e232642.pdf?refer=ehpprovider
- For Maine: http://www.anthem.com/provider/noapplication/f1/s0/t0/pw_e229816.pdf?refer=ahpprovider&state=me
- For New Hampshire: http://www.anthem.com/provider/nh/f5/s1/t0/pw_e229820.pdf?refer=ahpprovider&state=nh
The policy is also active on the site servicing the following states:
Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin.
It is important to work with your hospital reimbursement department to see if this policy is applicable to your jurisdiction.