Here we go again! I’ve been informed that clinicians in Anthem BCBS states are receiving the “you’re billing too many 90837 sessions compared to your peers” letters.
It’s become routine: occasionally Anthem will send letters which warns you’re billing 90837 more than the majority. But that’s a statistical impossibility if everyone in the network gets the same letter. Yeah, I failed my stats classes, but I DO know that not *everyone* can be billing 90837 significantly more than everyone else. If you’re looking at normal distributions (of anything), there will be roughly 50% below “average” and 50% above.
The “90837 intimidation letter” gives instructions to call to speak to care management, and therapists who do call, report that they are told, “oh, this was just educational, don’t worry about it.”
Then why send the letter?
From Anthem’s perspective: those letters might intimidate enough people into changing their billing patterns and using 90834. Even if each therapist only downcodes a couple visits per week to 90834, think how much money Anthem BCBS would save over 14 states.
I’m a firm believer in billing exactly what you document doing – no more, of course, but also no less. As long as your documentation is solid – let them audit. You always control your documentation, but one visit more or less of 90837 doesn’t guarantee you will (or won’t) be audited.
90837 intimidation is so last decade…it’s been going on since the invention of that procedure code in 2013.
