Becker's ASC Review

27 Coding, Billing & Collections Cigna Settles Shareholder Class-Action Lawsuits Over Anthem Deal: 5 Things to Know By Ayla Ellison B loomfield, Conn.-based Cigna has settled a string of shareholder class-action lawsuits that were filed over its proposed merger with ri- val health insurer Indianapolis-based Anthem, according to a recent Securities and Exchange Commission filing. Here are five things to know about the class-action lawsuits and the set- tlement. 1. Anthem entered into a definitive agreement to acquire Cigna in July in a cash and stock transaction valued at $54.2 billion. Under the deal, Cigna stockholders will receive $103.40 cash and 0.5152 Anthem common shares for each Cigna share. 2. Aer the merger was announced, Cigna shareholders filed class-ac- tion lawsuits claiming the deal undervalued Cigna. 3. Cigna did not admit any wrongdoing and said it agreed to settle the six class-action lawsuits "solely to avoid the costs, risks and uncertainties inherent in litigation." 4. Cigna did not disclose how much the company agreed to pay to settle the lawsuits. 5. If the settlement is approved by the court, the litigation will be dismissed, and "all claims that were or could have been brought in any actions challenging any aspect of the merger, the merger agreement and any related disclosures will be released," according to the SEC filing. n CMS Bumps Up Payments for Incomplete Colonoscopies: 3 Key Points By Carrie Pallardy T he 2015 CPT manual redefines an incomplete colonoscopy as a "colonoscopy that does not evaluate the entire colon," according to the American Gastroenterological Association. As a result, CMS is updating payments for incomplete colonoscopies. Here are three things to know. 1. Prior to 2015, incomplete colonoscopy was defined as a "colonos- copy that did not evaluate the colon past the splenic flexure." ese colonoscopies were reported with CPT code 45378 with modifier 53, paid at the same rate as sigmoidoscopy, according to the report. 2. Beginning Jan. 1, 2016, CMS will pay for incomplete colonoscopies reported with modifier 53 at "one half the value of the value of the inputs for these codes," according to the report. 3. Here are the 2016 non-facility payment rates for four incomplete colonoscopy procedures with modifier 53: • C-stoma (CPT code 44388): $178.42 • Diagnostic colonoscopy (CPT code 45378): $192.75 • Colorectal cancer screen, high risk (CPT code G0105): $192.40 • Colorectal cancer screen, not high risk (CPT code G0121): $192.40 n 9. Flexible sigmoidoscopy (CPT code 45330): -13 percent 10. Colonoscopy with control of bleeding (CPT code 45382): -16 percent "e direct effect of the decreased reimbursement is on the revenue of the physician or the practice," says Noel R. Fajardo, MD, of Las Vegas Gastro- enterology and e Las Vegas Surgery Center. "As in any business, profit margins will definitely decrease given that operational costs are not only fixed, but in most cases, continue to increase." Reimbursement cuts in the past have changed practice patterns with gastroenterologists limiting their availability to underinsured or uninsured patients. But, they continue to advocate on behalf of the patient. "Gastroenterologists are reacting to this in a very pragmatic way, engaging their professional societ- ies in efforts to have CMS better understand the impact of these cuts and to try to have CMS re- evaluate their decision," says Dr. Greenwald. Worst case scenario, GI providers will retire early, partially as a result of the lower reimbursements. "Given that a GI practices is a business that is run for profit, operational costs will be reviewed and will need to adapt to the decrease in CMS reim- bursements," says Dr. Fajardo. "However, the real- ity is a 20 percent decrease in reimbursement is sig- nificant and the efficiency of the practice will need to be scrutinized closely in order to eliminate cost." Private practice providers may also decide to take an employed or salaried position or merge with other practices to form supergroups that share operational costs. "In essence, solo GIs or small GI practices may eventually be part of a bigger network," says Dr. Fajardo. "at may or may not change the quality of care." e cuts could also affect access to care. "It may be difficult to extrapolate the direct impact on patient care and access to care, however, given that demand for colonoscopy will increase as our population ages, it would not be surprising to see a long wait list for obtaining a colonoscopy, therefore risking the pos- sibility of increased incidence of colon cancers due to delay in access to care," says Dr. Fajardo. e cuts also make gastroenterology a less attrac- tive specialty for new physicians coming out of medical school. e specialty may see a decline in gastroenterologists in the future. e cuts could have a disastrous effect on GI physicians' ability to provide colonoscopy and access to patient care. e cuts come at an espe- cially crucial time in the campaign to screen 80 percent of Americans by 2018; in 2010 only 59 percent of people 50 years or older had up-to-date colon cancer screenings. However, studies show increased colon cancer screening has lowered co- lon cancer rates 30 percent in the past 10 years. "My concern is that continued cuts in reimburse- ment might affect patient access in a profound way," says Dr. Greenwald. "It's hard to predict what will happen, and I am certain most gastro- enterologists will try to continue to find a way to provide access to care for the underinsured or uninsured. However, it would appear that reim- bursements for colonoscopy are diminishing at a time when the costs of providing that care are staying the same or even increasing. As reim- bursement gets closer to costs, the ability for phy- sicians to provide services is impacted, and access to care becomes an even more significant issue." n

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