tci ED Coding & Reimbursement Alert - 2019 Issue 3

You Be the Coder: EDs Brace for Payer Changes

Question: Our ED heard at a conference last weekend that our Blue Cross Blue Shield payer may stop paying for ED visits if the patient isn’t actually experiencing an emergency. But we can’t find anything online about it. Is this accurate? Mississippi Subscriber Answer: Unfortunately, you heard correctly. Blue Cross Blue Shield of Mississippi announced on December 18 that, effective in 2019, it would deny ED claims for conditions that it later believes did not “align with the severity of the diagnosis code submitted on the ER claim.” The policy requires patients to personally determine...

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