Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Commercial Payers

Anthem to Implement Post-Pay Reviews for ED Level 5 Claims in Some States; Indiana Currently Excluded

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

What Do Higher Levels of Service Say About What’s Happening in the ED?

An 85 percent increase per member in emergency department spending between 2009 and 2015 was the result of hospitals coding and billing for a greater number of high severity cases, according to a 2017 Health Care Cost Institute study. But what does this upward shift in evaluation and management levels say about what’s happening in the ED? READ MORE

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