February 06, 2011
Area(s) of Interest: Payor Issues and Reimbursement
Blue Shield announced changes to its physician fee schedule that will take effect March 1, 2011. In a notice recently sent to physicians, the insurer said that it would be increasing payment for some Evaluation and Management (E/M) services, but decreasing payment for others. The new rates are available at the Blue Shield website. You can also request a copy by completing the Allowance Review Form enclosed with the notice or by calling the Provider Services Department at 800-258-3091.
Blue Shield will, however, continue reimbursing for inpatient and inpatient consultations and will not follow the CMS 2010 policy change.
Physicians are encouraged to carefully review all proposed amendments to health plan or medical group/IPA contracts. CMA reminds physicians that they do not have to accept substandard contracts that are not beneficial to their practice.
To help physicians understand their rights when a health plan has sent notice of a material change to a contract, the California Medical Association (CMA) has published "Contract Amendments: an Action Guide for Physicians," available in the CMA Resource Library. The guide includes a discussion of options available to physicians when presented with a material change to a contract. Additionally, the guide includes a financial impact worksheet that will help physicians calculate the net impact of the changes on their practice.
Contact: CMA's reimbursement helpline, 888/401-5911 or email us.