DOI reversal could save Blue Cross members $16M
Posted November 19, 2012 4:22 p.m. EST
Raleigh, N.C. — The North Carolina Department of Insurance has reversed itself on whether insurers can change the way they reimburse hospitals and physicians for radiology services without renegotiating contracts.
Blue Cross Blue Shield of North Carolina said the move could save policyholders $16 million a year, including $5 million for the State Health Plan.
The state's largest insurer, Blue Cross last year tried to implement new reimbursement policies 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 last December that insurance companies needed to comply with state law requiring them to negotiate a new contract for changes in their fee schedule.
After a hearing on the matter, however, DOI ruled last week that limiting the amount paid for the technical component wasn't a change to the fee schedule, allowing insurers to begin issuing the lower reimbursements.