ED Coding & Reimbursement Alert - 2006 Issue 8
PHYSICIAN NOTES: Say Goodbye To Level Four E/M Visits In SW Ohio
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Article Overview
This piece is for physicians, coders, practice managers, and billing professionals who track payer policy changes affecting evaluation and management services. It focuses on a regional Anthem Blue Cross Blue Shield payment policy, discusses its impact on office and facility-based visit reimbursement, and briefly mentions a Medicare appeal transmittal, CMS spending projections, and a comment opportunity related to practice expense RVUs.
Why This Topic Matters
Regional payer edits and payment methodology changes can materially affect reimbursement patterns, documentation behavior, and contract expectations for physician practices. The article also highlights adjacent Medicare and CMS items that may be relevant to reimbursement and compliance monitoring.
Article Sections
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Regional Anthem payment policy change
Describes a payer policy in Southwest Ohio and Northern Kentucky that alters payment treatment for certain evaluation and management services. It explains the regional scope and the general reimbursement impact on affected practices.
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Related Medicare and CMS updates
Summarizes several short items on Medicare appeals guidance, CMS spending projections, and an opportunity to submit comments on practice expense valuation topics.
What You Will Learn
- How a regional payer policy can change reimbursement patterns for evaluation and management services
- Which types of services are affected by the payer policy at a high level
- What other Medicare and CMS reimbursement-related updates are mentioned in the article
- Who may be interested in monitoring regional payment policy changes and related CMS notices
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Practice managers
- Revenue cycle professionals
- Compliance teams
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