HORIZON: MSNJ Weighs-In on Payment Policy

This week, MSNJ requested in a letter to Horizon that it not reissue a payment policy that limited payment to one unit of radiopharmaceuticals used during nuclear stress tests. The Horizon payment policy was addressed in a class-action compliance dispute filed by our members.  The Compliance Dispute Resolution Officer issued an opinion finding that Horizon’s changed payment policy violated the national class-action settlement agreement by failing to give 90 days notice of the material change. All cardiologists in New Jersey who were reimbursed for only one unit when two were used, one at rest and one under stress, will be paid for both units as a result of this compliance dispute.
It is our understanding that Horizon is currently considering whether to reissue the payment policy with the required notice. Since the payment policy at issue is contrary to CPT®, HCPCS, and NCCI guidelines, CMS payment policies, and coding and reimbursement guidance from all the affected specialty societies, MSNJ has requested that Horizon not reissue the payment policy. The payment policy is an outlier from all other payers and will add to the administrative burden of practices that have to distinguish between payers on this issue. The affected specialty societies also sent a letter to Horizon. MSNJ is pleased to work with our members and the affected specialty societies to continue to support this ongoing effort.

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About MSNJ

Founded in 1766, the Medical Society of New Jersey is the oldest professional society in the United States. The organization and its dues-paying members are dedicated to a healthy New Jersey, working to ensure the sanctity of the physician–patient relationship. In representing all medical disciplines, MSNJ advocates for the rights of patients and physicians alike, for the delivery of the highest quality medical care. This allows response to the patients’ individual, varied needs, in an ethical and compassionate environment, in order to create a healthy Garden State and healthy citizens.

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