Anthem Blue Cross to review level 5 emergency room claims Anthem Blue Cross announced in its December Professional Network Update that, beginning January 1, 2016, it will initiate a pre-payment review of level 5 emergency department visits billed with CPT 99285 or G0384. Anthem has advised CMA that it will focus on level 5 emergency department visits that are billed in combination with diagnosis codes that “are an unlikely combination for high level visits.” The payor will exclude claims billed with critical care, observation or inpatient admissions. Claims with CPT codes 99285 and G0384 that are selected by Anthem for pre-payment ... February 3, 2016 General Emergency Departments, Emergency Rooms, Emergency Services, Anthem Blue Cross 0 0 Comment Read More »
Survey: ER visits continue to climb under Affordable Care Act A recent survey conducted by the American College of Emergency Physicians (ACEP) shows that emergency room (ER) visits are continuing to climb since the implementation of the Affordable Care Act (ACA), despite predictions that the law would result in less crowding. According to a news release, about three-quarters of the 2,098 ER physicians surveyed said that visits have risen since January 2014 — a significant increase from a year earlier, when less than half said they saw an upturn. More than one-quarter reported “significant increases in all emergency patients” since ... May 15, 2015 General, Managed Care Affordable Care Act, Emergency Rooms, Health Care Reform, ACA 0 0 Comment Read More »
Study finds that ACA Medi-Cal expansion could fuel ER use A retrospective study conducted by researchers at the University of California, San Francisco (UCSF) found that the number of visits to California emergency rooms (ERs) rose by 13.2 percent between 2005 and 2010, from 5.4 million to 6.1 million annually, with a significant 35 percent increase in the number of ER patients insured through Medi-Cal. The authors suggest that the Medi-Cal expansion under the Affordable Care Act (ACA) could further increase these numbers, as millions of additional patients become eligible for Medi-Cal in 2014. Researchers also found that Medi-Cal patients ... September 20, 2013 Medi-Cal Emergency Physicians, Emergency Rooms, Insurance/Reimbursement, Medi-Cal, Medi-Cal Cuts, Access to Care 0 0 Comment Read More »
Physicians urged to call Gov. Brown and ask him to sign the Maddy EMS Fund bill The California Medical Association (CMA) and the American College of Emergency Physicians (ACEP) are cosponsoring a bill that will extend funding for the Maddy Emergency Medical Services (EMS) Fund. Without this bill (SB 191/Padilla), providers of emergency medical care throughout the state will lose $50 million per year that is currently used to offset the costs incurred for care provided to uninsured patients in hospital emergency rooms (ER). Without this bill, the law that authorizes the Maddy Fund is set to expire on January 1, 2014. Although the bill is ... August 8, 2013 General EMS/MADDY Funds, Access to Care, Advocacy, Emergency Rooms 0 0 Comment Read More »
