June 25, 2010
BCBS to announce fee schedule July 1
Representatives of Blue Cross Blue Shield of Alabama informed MASA's Third Party Task Force in May of its intent to announce a new fee schedule on July 1, with implementation being October 1. In the development of its fee schedule, BCBS stressed the importance of addressing quality, affordability and access. Read more
June 8, 2010
BCBS physician quality data available nationwide in July
On July 1, 2010, Blue Cross Blue Shield (BCBS) members from across the country will be able to view Alabama doctor’s clinical performance information on the Blue National Doctor and Hospital Finder. BCBS began publishing quality indictor data to its local Doctor Finder Web site on July 1, 2009. The data has been refreshed to display Quality Measurements for measurement year July 1, 2008, through June 20, 2009, Read more
February 15, 2010
BCBS removes PAP privelege from providers with increases in imaging utilization
To address this over utilization, approximately 400 of 1,800 physicians in the PAP are now required to meet full pre-certification requirements. Read more
February 15, 2010
BCBS re-evaluates quality of imaging facilities
Blue Cross Blue Shield has sent a survey to approximately 140 free standing imaging facilities to gather information pertaining to ownership, equipment quality, and qualifications of the equipment operators. Read more
January 21, 2010
NOTICE: BCBS Provider Facts
Recently, MASA became aware that many physicians did not know that Blue Cross and Blue Shield of Alabama discontinued mailing ProviderFacts and Special Bulletins. These publications are now sent via e-mail only.
Assure BCBS has an accurate e-mail address for your practice by completing their Provider E-mail Update Form.
November 3, 2009
BCBS to delay implementation of PMD fee schedule changes
Blue Cross Blue Shield of Alabama announced on Nov. 3 that it will delay the implementation of its recently announced fee schedule, which was originally scheduled to go into effect on Dec. 1. At this time the anticipated effective date for the new BCBS fee schedule will be no later than July 1, 2010. More details about the new payment methodology is to be posted on the BCBS Web site. Read more
October 21, 2009
MASA hosts Presidents' Forum to discuss changes to PMD fee schedule
The MASA leadership hosted a Sept. 30 President's Forum via conference call with more than 40 county and specialty society leaders and staff to discuss the general impact of BCBS's change to an RBRVS based system. Read more
MASA meets with BCBS to discuss changes to PMD fee schedule
MASA's Third Party Task Forse met with Blue Cross Blue Shield of Alabama representatives on Sept. 15 to discuss the announcement of their plans to implement a new payment methodology for the Preferred Medical Doctor (PMD) progam.
In the meeting, Blue Cross explained that the change to an RBRVS based system is only one of three components to consider when assessing the financial impact on a practice. The other components are the recognition of modifiers and "unbundling" of some services.
BCBS has committed to create an online tool to allow PMD physicians to assess the impact of their fee schedule and payment changes. October 2 is the target date for this tool to be accessible through their website, and BCBS will notify PMD physicians of the exact date it will become available. Read more
BCBS to implement new payment methodology for Preferred Medical Doctors
MASA has been informed that Blue Cross and Blue Shield of Alabama (BCBS) will implement a new payment methodology for the Preferred Medical Doctor (PMD) program. Since the inception of the program, PMD fee schedule allowances have been adjusted periodically based on a code-by-code basis, rather than on a comprehensive fee schedule basis. According to BCBS, the old code-by-code basis resulted in inconsistencies in valuations. Consequently BCBS decided to adopt a new payment methodology that will more accurately and consistently price specific code procedures based on their related complexity.
Effective Dec. 1, BCBS will begin a multi-year transition to the Resource Based Relative Value Scale (RBRVS), a nationally recognized payment methodology that has been tested, evaluated and implemented by the majority of payers nationwide. Concurrently, the locally developed fragmented coding edits will be replaced by the National Correct Coding Initiative (NCCI) standards. The adoption of RBRVS and NCCI is not expected to affect the aggregate PMD network payout. Payment for some Current Procedural Terminology (CPT) codes will increase while others will decrease as a result of this process. Read more
BCBS to evaluate imaging precertification and PAP programs
In April 2006, Blue Cross and Blue Shield of Alabama (BCBS) created a precertification program to address growing concerns about the rapid rise in the costs and utilization of outpatient diagnostic imaging in Alabama.
In its monitoring of utilization of advanced imaging BCBS has noticed that utilization trends are increasing at similar rates to those observed before implementation of the precertification program in 2005. As a result of these trend increases, BCBS is re-evaluating the current precertification and Preferred Authorization Process (PAP) programs. Read more
BCBS to terminate InfoSolutions
As of Dec. 31, 2009, Blue Cross and Blue Shield of Alabama will retire the InfoSolutions® Medical Information Network and all InfoSolutions Provider Agreements will be terminated. Pursuant to terms of the agreement, all information stored in the InfoSolutions repository, excluding demographic data, will be destroyed by Jan. 31, 2010, unless they receive written notice from a provider by Oct. 1, 2009, requesting that the contributed data be returned. Read more