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Court upholds changes to radiology reimbursements

Posted December 13, 2013

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— 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.

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  • DontVote4LiarsCheatsOrThieves Dec 18, 2013

    hp277 - "A reduction of health care costs is a good thing for everyone."

    Only if the reduction filters down to EVERYONE and doesn't stay in the pockets of the fat cats at the top of insurance firms or medical facilities.

  • DontVote4LiarsCheatsOrThieves Dec 18, 2013

    "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."

    So the DOI changed it's own mind? When interpreting law, if that happens, I question if they know the law. I know there are gray areas, but c'mon now.

  • hp277 Dec 13, 2013

    I wonder how much of that will be rebated to consumers (haha,that's a good one!), how much of that savings will go to exorbitant executive compensation, how much will go to palatial facilities, and how much will be invested in competing for market share, which I always thought was contrary to the purpose of a nonprofit like BCBS.
    jdraleigh

    A reduction of health care costs is a good thing for everyone.

    Under the ACA, BCBS has to spend at least 80% of premiums on health care. All that stuff you cited is limited to 20% of the premiums, so if that $30 million saved pushes the health care spending below 80%, then subscribers get a refund from BCBS. Cool, huh?

  • jdraleigh Dec 13, 2013

    ...The change has saved the company more than $30 million, she said...

    I wonder how much of that will be rebated to consumers (haha,that's a good one!), how much of that savings will go to exorbitant executive compensation, how much will go to palatial facilities, and how much will be invested in competing for market share, which I always thought was contrary to the purpose of a nonprofit like BCBS.