Payment Integrity Evaluation & Management (E/M) Over Coding Concept Moving to Retrospective

Blue Cross Blue Shield of North Dakota (BCBSND) wants to inform providers of a change to the Evaluation & Management (E/M) payment integrity concept implemented in April of 2023. Please refer to the previous HealthCare News article; New Payment Integrity Prospective Concept: Evaluation & Management (E/M) Over Coding.  

In late October 2023, this concept will move from a prospective concept to a retrospective concept. As part of this change, medical records will now be requested as part of the review process. We will continue to review level 4 and 5 E/M codes billed by identified outlier providers.