Back in June, BCBSNC announced a new Corporate Medical Policy that would unilaterally reduce reimbursement for certain radiology procedures performed during the same outpatient patient session. Specifically, the policy would cut reimbursement of the technical component by 50% on second and subsequent CT/CTA, MRI/MRA, and ultrasound imaging procedures.  BCBSNC scheduled the policy to take effect on October 1.

NCMS quickly informed BCBSNC of our 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 explained the Policy primarily as an effort to get in line with its commercial competitors, many of which have already implemented similar policies inspired by Medicare’s highly-controversial multiple procedure payment reduction policy.

In a meeting late last week between the NC Medical Society, NC Radiological Society, and the NC Hospital Association, representatives from BCBSNC disclosed that the Radiology Services Reimbursement Policy would be revised and reissued with another 60-day notice period. That occurred on September 30, with the new effective date set for December 1, 2011. Read BCBNSC’s statement on the change and the revised policy here. 

While we count the delayed implementation as significant progress, the NCMS still takes the position that the revised policy is not being implemented in compliance with state law.  Therefore, in the weeks leading up to December 1, we will be continuing our conversations with BCBSNC, working to persuade them to withdraw the policy, and moving to ensure that BCBSNC complies with our state’s fair contracting laws.