United Healthcare will begin evaluating all level 5 professional Emergency Department claims and potentially downcoding them or denying them for “inappropriate” coding. The new policy, which takes effect April 1, 2020, is part of the payer’s “continued efforts to reinforce accurate coding practices.” READ MORE
CMS recently published the final draft of the Medicare Physician Fee Schedule for 2020. In addition to changing the payment rates for 2020, the Final Rule also mandates changes to several payment policies. We’ve highlighted a few of the biggest changes that would be most interesting to emergency physicians. READ MORE
Researchers estimate as many as one in eight ED visits by adults and one in 10 ED visits by pediatric patients are linked to mental illness and substance use disorders in the US. And those numbers are rising, according to a pair of recent studies. But what can be done? READ MORE
Starting January 1, 2019, all Hoosier healthcare providers who hold a controlled substance registration are required to register for Indiana’s INSPECT program and some practitioners are required to check the database before prescribing an opioid or benzodiazepine to a patient. A recent update to the law clarifies the requirements and moves the law from criminal statute to professional licensing statute. READ MORE
CMS recently published the proposed Medicare Physician Fee Schedule for 2020, including several changes that will impact emergency physicians. READ MORE
Managed Health Services will begin post-payment reviews of level 5 emergency department claims for their Hoosier Healthwise, Healthy Indiana Plan (HIP), and Hoosier Care Connect plans in September 2019. READ MORE
As the surprise billing debate continues, emergency physicians have begun lining up behind one bipartisan House bill. READ MORE
Just weeks after Anthem announced then retracted a new post-payment review policy for emergency department level 5 services for its commercial plans in some states, the payer has now announced that the policy will be implemented for Medicare Advantage plans in most states where Anthem conducts business. READ MORE
Anthem Blue Cross and Blue Shield recently announced a new policy of post payment reviews of professional ER claims billed with level 5 E/M codes. The new policy is being implemented to “ensure documentation meets or exceeds the components necessary to support its billing,” according to Anthem, and will begin August 1. Indiana and a few other states currently are excluded. READ MORE
A trio of recent studies pulls back the curtain on the growing number of emergency department visits in the United States, revealing how presenting symptoms, geographical location, and insurance coverage (or the lack thereof) influence usage. READ MORE
