Harvard Pilgrim is updating our Evaluation and Management Payment Policy, effective for dates of service beginning Dec. 15, 2017.
With the update, Harvard Pilgrim’s policy concerning reimbursement for multiple evaluation and management (E&M) services provided to the same patient, on the same day will not distinguish between outpatient and inpatient E&M services. Additionally, reimbursement will be based on federal tax identification number (TIN) and specialty/subspecialty — regardless of whether the visits are for related diagnoses.
If multiple providers in the same billing group (using the same TIN) and of the same specialty provide inpatient or outpatient E&M services to the same patient on the same date of service, Harvard Pilgrim will reimburse only the E&M service with the highest allowable amount.
For more information, please refer to Harvard Pilgrim’s updated Evaluation and Management Payment Policy.