Blue Shield of California recently notified physicians of changes to its standard physician fee schedule that will take effect July 1. In a letter to physicians on May 1, Blue Shield notified physicians that it would be making changes to the fee schedule, but failed to provide details about the changes. The letter says only that Blue Shield plans to modify payment levels for many CPT codes, some being increased and others decreased.
CMA believes that this type of “notification” is not only unfair and burdensome, but also illegal. State law requires health insurers to provide physicians with at least 45 days advance notice of any material change to their contracts, and the opportunity to terminate the contract before the change takes effect. “First, there is no notice of the change,” wrote CMA legal counsel Astrid Meghrigian in a letter to Blue Shield last week. “The letter does not provide underlying information concerning the change itself; rather, it merely notifies providers that there will be changes and sets forth a complicated process for providers to follow in the event they wish to know what these changes are.” CMA also believes that Blue Shield is required by law to provide fee schedule information electronically. Currently, physicians must either call or fax a request to the insurer and wait 10 days for a response.
Although CMA has asked Blue Shield to postpone implementation of these fee schedule changes and provide physicians with electronic access to the new rates, you should not wait to begin assessing the impact the changes will have on your practice. To help you, CMA has published a toolkit available free to members at CMA’s members-only website, http://www.cmanet.org/member. Included in the toolkit is CMA’s financial impact worksheet, which will help you calculate the impact of the fee schedule changes based on your most commonly billed CPT codes.
Physicians are also urged to read CMA’s contracting toolkit, “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting.” This toolkit was designed to help physicians analyze proposed fee schedules and negotiate and manage complex third-party payor agreements. It is available free to members at the members-only website. Nonmembers can purchase the toolkit for $100 in the CMA bookstore, http://www.cmanet.org/bookstore.
