Medicare Compliance & Reimbursement - 2017 Issue 7
E/M Coding: Is UHC's New Policy Negatively Impacting ED Physicians?
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Article Overview
This piece examines a payer policy update from UnitedHealthcare that affects emergency department evaluation and management coding, with attention to how documentation is assessed for higher-level ED visits. It is aimed at coders, emergency department billers, compliance staff, and physicians who need to understand the policy’s potential impact, the areas of disagreement in the industry, and the role of appeals when claims are denied. The article focuses on the general coding issue, the policy language, and the practical questions raised by differing interpretations.
Why This Topic Matters
Emergency department documentation and level selection can influence claim support, payer reviews, and appeals. Understanding payer-specific E/M policy changes helps coding and billing teams evaluate whether chart documentation aligns with the payer’s expectations and where disputes may arise.
Article Sections
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Policy update affecting emergency department E/M scoring
Summarizes the payer policy change and its effect on how emergency department encounters are evaluated for documentation support. The section frames the broader issue without providing code-selection details.
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What the change means
Discusses how the policy is being interpreted by emergency department staff and coding professionals. It also presents the broader industry disagreement around terminology and documentation review.
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Is there recourse?
Covers the possibility of appealing denied claims and the general considerations raised when documentation is challenged under the payer’s policy. It also notes participation status as part of the broader discussion.
What You Will Learn
- How a payer policy update can affect emergency department E/M documentation review
- Why the concept of additional workup is being debated in ED coding
- What kinds of follow-up actions may be considered when a claim is denied
- How payer participation status can factor into discussions about claim review
Who Should Read This
- Emergency department physicians
- Medical coders
- Coding auditors
- Billing staff
- Compliance personnel
- Practice managers
Codes Discussed
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