Anthem Blue Cross recently notified physicians of changes to its Prudent Buyer physician fee schedule that will take effect September 1, 2011. In a letter to physicians on May 23, Blue Cross informed physicians that it would be increasing payment levels for many evaluation and management (E/M), preventive care, ER, after-hours, and chemotherapy administration services. While Blue Cross will continue recognizing consultations codes, the insurer will be decreasing payment levels for those codes.
The notice also advises of changes to the number of Payment Areas statewide, reducing the total from eleven to nine, changes to reimbursement methodology for obstetric anesthesia and therapy services, and changes to the multiple procedure payment reduction for the technical component of diagnostic imaging. Additionally as part of the fee schedule update, workers’ compensation claims will be reimbursed at the lesser of the Prudent Buyer fee schedule or the Workers’ Compensation Official Medical Fee Schedule.
Physicians can obtain a complete copy of the new fee schedule on the Blue Cross website (log in and select the "Prudent Buyer Fee Schedule Update" link under the "What’s New" section).
The California Medical Association (CMA) urges physicians to assess the impact this fee schedule update will have on their practice as soon as possible. If you find that the new fees are not acceptable or sustainable and wish to exercise your right to terminate, you must do so in writing no later than August 5 (approximately 45 business days from the date of receipt of the notice from Blue Cross) to be effective on September 1.
CMA has created a financial impact worksheet to help physicians assess the impact the fee schedule changes will have on their practices based on their most commonly billed CPT codes. This worksheet is available to members only.
To help physicians understand their rights when a health plan has sent notice of a material change to a contract, CMA has published "Contract Amendments: an Action Guide for Physicians." The guide includes a discussion of options available to physicians when presented with a material change to a contract.
If you have questions about the new contract terms, contact Blue Cross Provider Relations at (855) 238-0095 or email@example.com.
Contact: CMA’s reimbursement helpline, (888) 401-5911 or firstname.lastname@example.org.