Physicians are urged to carefully review all notices from their contracting health plans, as these may include material modifications to contract terms that could significantly impact their practices. You should also be aware that you have the right to terminate an agreement if any such material change is not beneficial to your practice.
There have been a number of recent developments that demonstrate the importance of such vigilance by physicians and their staff.
1. MultiPlan/Private Health Care Systems (PHCS) merger
Although MultiPlan and PHCS will continue to market their products under different names, physicians were recently notified that effective May 1 the PHCS agreement will supersede any other agreement in place. In other words, physicians’ relationships with MultiPlan will be governed by the PHCS agreement. Physicians were also notified that effective May 1 the newly merged entity will adopt MultiPlan’s practice of tying fee schedules to the current year’s RBRVS. This new policy will significantly decrease the current PHCS fee schedule.
2. First Health Acquisition of Community Care Network
Physicians were recently notified that Community Care Network (CCN) would be absorbed into the First Health network. Physicians should be aware that the First Health physician contract supersedes the CCN contract and physicians treating CCN patients will be paid according to the First Health fee schedule for dates of service on or after January 1, 2007. (CCN patients will eventually be issued new First Health cards.) Because there was no change to the First Health fee schedule, the plan was not required to give physicians advance notice or the option to terminate.
Physicians should be aware that they do have the right to terminate any health plan contract “without cause” with advance written notice. (The amount of advance notice will depend on the terms of the contract.)
3. Blue Cross Prudent Buyer Plan Fee Schedule Changes
CMA recently learned that Blue Cross recently updated its Prudent Buyer Plan physician contract and the new contract becomes effective June 1. According to a notice recently mailed to physicians, payment levels for many codes have been modified, some increased and some decreased. Physicians are urged to assess the impact these changes will have on their practice. The new fee schedule will be available on the Blue Cross provider website on April 15. In the meantime, fee schedule questions should be directed to Blue Cross at 800/933-6633 (select option 3).
To help physicians analyze proposed fee schedules and negotiate and manage complex third-party payor agreements, CMA has published a contracting toolkit, “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting.” This toolkit is available free to members at the members-only website Nonmembers can purchase the toolkit for $100 in the CMA bookstore.
CMA has also created a financial impact worksheet to help physicians assess the impact fee schedule changes will have on their practices based on their most commonly billed CPT codes.
Click here for more information on these and other practice management resources from CMA.
