ABI recently learned Coventry is rounding down partial anesthesia time units of 4 minutes or less (i.e. if an anesthesia case is 19 minutes, we bill 2 time units; however, you would only get paid for 15 minutes, 1 time unit, rather than 2 units). As most of you are aware, Coventry recently purchased Preferred Health Systems, “PHS”. PHS historically rounded up to the next whole unit for partial time units. Coventry recently converted all PHS claims’ processing to the Coventry system; and in doing so, made the change to rounding down on 4 minutes or less.
Insurance companies who do not pay a full unit for partial time units should have a published policy and procedure explaining how they pay time units. The company does have the choice in how they process time units; however, this should be published in a manner providers can have access, as this affects reimbursements. The provider is contractually bound to abide by an insurance company’s policy and procedures, but the company is obligated to publish those and are limited on when policies can be changed. Coventry does not have any sort of written policy describing how they are currently paying time units. In confronting Coventry regarding this issue and where the policy and procedure is to support the rounding down, they have confirmed there is no written published policy.
If you would like to discuss this issue further or have questions, please contact Stephanie Kurtz at (316) 281-3710.
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