As previously reported in CMA Alert in June 2011, Blue Cross sent letters to approximately 3,500 providers advising that their use of level 4 and 5 evaluation and management (E&M) codes was greater in frequency (90th percentile) than others in their specialty. The letter asked that physicians voluntarily submit medical records on five specific patients so Blue Cross could provide them with feedback and education on their coding.
Approximately 600 physicians received similar letters advising that their use of level 4 and 5 E/M codes was in the 80th percentile, but were not asked to provide records.
CMA has learned that in late December, the Blue Cross Provider Audit team identified an error that incorrectly labeled 2,800 physicians as outliers of these high-level codes. In late December and early January, Blue Cross sent letters to affected physicians acknowledging and apologizing for the mistake, advising physicians that they have put additional measures into place to ensure accurate findings for future reviews.
Questions about the letter should be directed to Blue Cross at (404) 842-8460 or via email at CPTCoding@anthem.com.
No funds were recouped as a result of the audit; rather, the Blue Cross analysis and feedback were educational in nature.
Contact: CMA reimbursement helpline, (888) 401-5911 or firstname.lastname@example.org.