Court upholds changes to radiology reimbursements
Posted December 13, 2013
Raleigh, N.C. — A Superior Court judge has upheld a decision by the North Carolina Department of Insurance to allow insurers change the way they reimburse hospitals and physicians for radiology services without renegotiating contracts.
Blue Cross Blue Shield of North Carolina tried to implement new reimbursement policies in 2011 to cut the amount hospitals and physicians receive for the "technical component" of scans – everything from checking a patient in to handing him or her a gown – when several scans are performed at once.
Blue Cross and fellow insurer Aetna said they were being billed multiple times for such services, which were provided only once.
When hospitals and physicians balked at the change, the DOI issued a preliminary ruling that insurance companies needed to comply with state law requiring them to negotiate a new contract for changes in their fee schedule.
The DOI reversed itself in November 2012, determining that limiting the amount paid for the technical component wasn't a change to the fee schedule, which allowed insurers to begin issuing the lower reimbursements.
Blue Cross spokeswoman Michelle Douglas said the insurer implemented a new billing policy this year that pays practices 100 percent of the technical charge on the first image and 50 percent on subsequent images. The change has saved the company more than $30 million, she said.