General Surgery Coding Alert - 2018 Issue 3
ED Payments: Anthem Extends Policy Denying "Inappropriate" ED Visits to 3 More States
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Article Overview
This article discusses a private insurer’s expansion of a policy that reviews certain emergency department claims as potentially non-emergent, and the resulting criticism from emergency physicians and lawmakers. It is relevant to readers following payer policy changes, emergency medicine billing issues, and the broader debate over patient evaluation standards and claim denial practices.
Why This Topic Matters
The article matters because it highlights a payer policy change affecting emergency department reimbursement and the concerns it raises for patients, clinicians, and policymakers. It also helps stakeholders understand the kind of nonclinical coverage disputes that can affect claim outcomes and access to care.
What You Will Learn
- How a private insurer’s emergency department claim review policy was expanded geographically
- Why emergency physicians and lawmakers objected to the policy
- What broader concerns the article raises about patient self-assessment and emergency care access
- Which organizations and public officials are involved in the dispute
Who Should Read This
- Emergency department physicians
- Medical coders
- Billing and reimbursement staff
- Health policy analysts
- Practice managers
- Hospital revenue cycle teams
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