Physicians recently received a letter from Blue Shield of California, notifying them of fee schedule changes that take effect July 1. To ensure physicians have timely access to all of the information necessary to evaluate the impact the proposed changes will have on their practice, CMA has contacted the insurer to request clarification on a number of issues.

Among the questions CMA has asked:
 

• Can physicians access the fee schedule online?: Included with the letter was a “provider allowance review” form to be used to request reimbursement amounts by CPT code. Unfortunately, the form only allows physicians to list 19 codes at a time and also requires the requestor to include the physician’s customary charge. CMA believes that the administrative hassle of manually listing each code and customary charge, combined with the insurer’s 20-business-day response time, makes this an unnecessarily cumbersome process. CMA is also concerned that the 20-day turnaround would put Blue Shield in violation of state law, which requires insurers to give 45 days’ notice of any material contract changes. CMA has urged Blue Shield to provide physicians with an alternate electronic means of accessing this information.
• What services will be impacted by the “multiple services payment policy”?: The letter also announced Blue Shield’s new multiple services payment policy, which will in some circumstances reduce reimbursement for multiple procedures provided on the same day. According to the letter, the initial service will be covered at 100 percent and the allowance for subsequent services will be “reduced.” CMA has asked Blue Shield to provide physicians with details on the codes affected by this new policy and the amount of the fee reductions.

Stay tuned to future issue of CMA Alert for more details.

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.

Contact: CMA’s Reimbursement Help Line, 888/401-5911 or jblack@cmanet.org.