The California Medical Association (CMA) has just learned that Blue Shield notified physicians in March of changes to its physician fee schedule that will take effect June 1, 2012. In the notice, Blue Shield informed physicians that it would be increasing payment for some Evaluation and Management (E/M) services.
Blue Shield also reports that it will continue reimbursing for inpatient and inpatient consultations and will not follow Medicare's 2010 policy change.
The new rates are available at the Blue Shield website (under Helpful Resources click "Professional Fee Schedule," then enter "06/01/2012" in the date of service field to view fees effective 6/1/12). Physicians can also request a copy of the new fees by completing the allowance review form enclosed with the notice, or by calling the Blue Shield Provider Services Department at (800) 258-3091.
Physicians are encouraged to carefully review all proposed amendments to health plan or medical group/IPA contracts. Physicians who do not agree with the proposed change have the option to terminate the contract. Because language can differ, physicians are encouraged to review their contracts for specific guidance on termination.
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. The guide also includes a financial impact worksheet that can be used to calculate the net impact of the fee schedule changes to a practice.
Click here to view a copy of the notice that was recently sent to physicians.
Contact: Reimbursement Helpline, (888) 401-5911 or firstname.lastname@example.org.