APMA advocacy staff met with Aetna leadership as part of APMA's ongoing quarterly discussions with the insurer. The conversation focused on prior authorization, documentation and coding oversight, and emerging coverage policies relevant to podiatric physicians.
Aetna shared updates on its participation in AHIP's prior authorization modernization initiative. The effort is focused on standardizing administrative intake and documentation requirements to reduce provider burden. While foot and ankle services are not included in the initial phase, APMA emphasized the importance of ensuring podiatric physicians are included as this work expands.
APMA and Aetna also discussed recent Office of the Inspector General (OIG) findings related to podiatrists’ claims for evaluation and management (E/M) services billed with modifier 25 and podiatrists' routine foot care claims. Aetna characterized these findings as largely documentation-driven and focused on true outliers, with no indication of increased enforcement trends specific to podiatry at this time. APMA released a statement regarding the OIG report.
Finally, Aetna shared operational and coverage updates, including shorter utilization management turnaround times driven by Centers for Medicare and Medicaid Services (CMS) requirements and their impact on providers. In addition, Aetna communicated its intent to follow finalized Medicare local coverage determinations (LCDs) for skin substitute coverage.
APMA has created a Skin Substitutes Resource page to help members navigate changes. APMA will post updates to this page as well.
Members with questions or concerns are encouraged to contact the APMA Advocacy team.