As previously reported in CMA Alert, Blue Cross of California recently notified physicians of changes to its Prudent Buyer fee schedule. According to a notice mailed to physicians, payment levels for many codes have been modified, some increased and some decreased. Physicians are urged to calculate the impact of these changes on their practices before the fee schedule takes effect August 30. You should also be aware that you have the right to terminate an agreement if any “material change” to the contract terms is not beneficial to your practice.

CMA has published a Blue Cross of California Survival Kit to help you assess the impact fee schedule changes will have on your practice based on your most commonly billed CPT codes. The tool kit answers frequently asked questions and discusses the options for physicians who determine that the new contract terms would negatively impact their practices. The new fee schedule will be implemented on August 30. It was originally scheduled to take effect June 1, but the insurer was forced to delay implementation after the Department of Managed Health Care received hundreds of complaints from CMA physicians about Blue Cross’s failure to provide physicians with timely access to the new rates.

The Blue Cross of California Survival Kit is available free to CMA members.

Click here to download the survival kit.

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