February 06, 2011
Area(s) of Interest: Payor Issues and Reimbursement Commercial Payors
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.
Download a copy of the notice that was recently sent to physicians.
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 Economic Services.