[Ohioaap-practicemanagers] Anthem letter about coding utilization

[Michael Chamberlin]

One of our physicians recently received the attached letter.  It says that
her "use of high level established E&M codes (99214-15) appear to fall
outside the utilization parameters."  They are planning on watching her
closely over the next 6 months and if there is "an improper use of such
codes," they will "reduce the applicable reimbursement level for such
codes."  (Note that "reimbursement" was there word not mine.)

When I called the number on the letter, I was told that 5 out of 15 claims
were 99214-215 over a period of time.  I mentioned that 33% would be
consistent with the national average and they agreed with me.  Of course,
they then back tracked and said that this was just an opportunity to for us
to review her coding and documentation.  Of course, they have not asked for
documentation for any of these visits and were not able to tell me what
patient visits they had included in this.

Has anyone else received a letter like this recently from Anthem or BCBS?
Has anyone seen their payment decreased due to a process such as this?  It
seems like they are just trying to intimidate us with this letter, but that
is not going to happen.

Thanks in advance for your help,

Mike


-- 
Michael Chamberlin, M.D., FAAP
Pediatric Assoc. of Mt Carmel
4371 Ferguson Dr
Cincinnati, OH  45230
513-752-3650
513-752-3387 (fax)
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