Blue Cross Retreats on Imaging Reimbursement Reductions

After an almost year-long dispute, Blue Cross and Blue Shield of North Carolina released a statement this week to announce they are again delaying implementation of a controversial corporate medical policy that would have unilaterally cut reimbursement by $16 million a year for certain radiology procedures.

The statement, released May 21, comes amidst BCBSNC’s appeal at the DOI after a joint complaint was filed last October by the NCMS, NC Radiological Society and NC Hospital Association over concerns about the legality of the proposed policy change’s implementation.

The statement goes on to say BCBSNC will maintain a hold on the policy’s implementation and will not apply it to claims submitted by any providers at this time, including those who agreed to its implementation.

The three provider organizations have successfully argued that before BCBSNC could change reimbursement rates, BCBSNC had to follow the formal contract amendment process set out in state law. The DOI agreed, and instructed BCBSNC that, in order to implement the policy, the insurer must first amend its contracts with affected physicians and facilities. BCBSNC then appealed the DOI’s decision.

Earlier in the appeal, BCBSNC sent out contract amendments to all affected health care providers in their network, seemingly in compliance with the DOI’s original decision.  This week’s statement claimed the contracting effort was done “under protest.”

“However, the majority of providers contacted by BCBSNC objected to the new policy, thereby blocking implementation of the policy as an amendment to their provider contracts,” reads the statement.

The new policy would have reduced reimbursement by 50 percent on second and subsequent CT/CTA, MRI/MRA, and ultrasound imaging procedures performed during the same outpatient patient session.

Since the change’s initial proposal last June, the NCMS expressed to BCBSNC concerns that a unilateral policy change that modified radiology reimbursement rates could not be implemented without first informing the affected medical practices and following the contract amendment process outlined in state law. BCBSNC has attempted to justify its methods as part of an effort to get in line with its competitors, some of which have already implemented similar policies inspired by Medicare’s highly-controversial multiple procedure payment reduction policy.


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