On September 1, 2020, Blue Cross and Blue Shield of Minnesota (Blue Cross) implemented a new initiative to ensure Emergency Department providers are reimbursed accurately based on the level of services provided.
Summary
As the cost of health care continues to rise, Blue Cross is committed to improving the sustainability of care by ensuring high-quality, appropriate care is delivered at a fair price and billed appropriately for the services provided to our members.
To that end, Blue Cross has implemented a new reimbursement policy to help ensure Emergency Department providers are reimbursed accurately.
This policy only applies to Commercial and Federal Employee Program (FEP) lines of business.
Next steps for providers
Blue Cross will not initially deny or recoup ED claims as a result of this reimbursement policy. Instead, level 4 and 5 ED visit claims data will be reviewed on a post-payment basis and shared with providers that have a higher utilization of these codes compared to peer providers. The expectation is that this additional clarity and information will support improved coding to most accurately reflect the level of ED care delivered.
Providers are asked to:
- Review the reimbursement policy, including the criteria Blue Cross will use to determine the appropriate level of reimbursement as applicable for ED services
- Adjust internal policies and procedures to ensure alignment with this policy
- Review data reports from Blue Cross on utilization of levels 4 and 5 ER codes and readjust billing practices accordingly
More information
Provider bulletin
A provider bulletin outlining this change was posted on July 1, 2020.
Provider bulletin on emergency department level of service coding reimbursement policy (PDF)
Reimbursement policy
This is not a change in medical policy or member benefits, but a change in reimbursement policy. Reimbursement policies are updated on an ongoing basis and used by Blue Cross to define if and how certain claims will be paid for various health care services.
Blue Cross will not be denying claims or recouping payment as a result of this reimbursement policy at this time.