On July 1, Indianapolis-based Anthem ended coverage of hospital-based MRIs and CT scans without prior approval in Indiana, Kentucky, Missouri and Wisconsin, and expanded the policy to Ohio Sept. 1. Hospitals will need to submit a precertification request for any patient receiving an MRI or CT scan at the facility, and in most cases the imaging service will only be covered at the hospital if Anthem deems the request medically necessary, among other factors.
The change aims to incentivize the use of cheaper alternatives at freestanding facilities. However, Leah Binder, president and CEO of the Leapfrog Group, told Kaiser Health News the policy may be at odds with quality improvement initiatives.
“To achieve true value, you have to have high-quality care at a good price. Anthem would be better off judging the quality of these [imaging] diagnoses” than setting payment based on where they are provided.
To learn more about the change in policy, read the FAQ from Anthem.
For the full Kaiser Health News report, click here.
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