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Anthem Blue Cross Starts Prepayment Review on Level 5 Emergency Department E/M Medicare Claims

By David McKenzie, CAE | on April 13, 2016 | 0 Comment
Features
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Although it is reasonable for Anthem, or any plan, to perform audits of claims received, widespread prepayment audits without indication of prior cause for concern seems unfair and presents a challenge to the fragile health care safety net the ED provides to the community and the managed Medicare population.

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Explore This Issue
ACEP Now: Vol 35 – No 04 – April 2016

Mr. McKenzie is reimbursement director for ACEP.

Online Resources

ACEP has resources in the Reimbursement area, which include a paper offering valid reasons for the shift to a greater frequency of higher-acuity ED E/M codes and how to prepare for, and defend yourself from, payer audits.

Pages: 1 2 | Single Page

Topics: Anthem Blue CrossBillingCodingEmergency DepartmentEmergency MedicineEmergency PhysicianMedicareMedicare & MedicaidPatient CarePractice ManagementReimbursement

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