Blue Shield of California Fee Schedule Changes Effective June 2012 May 14, 2012 Payment, Practice Management payor contract, Blue Shield, insurance/reimbursement 0 SFMS/CMA has learned that Blue Shield has notified physicians of changes to its physician fee schedule that will go into effect June 1, 2012. In the notice, Blue Shield informed physicians that it would be increasing payment for some Evaluation and Management (E/M) services. Blue Shield also reports that it will continue reimbursing for inpatient and inpatient consultations and will not follow Medicare’s 2010 policy change. The new rates are available at the Blue Shield website. Physicians can also request a copy of the new fees by completing the allowance review form enclosed with the notice, or by calling the Blue Shield Provider Services Department at (800) 258-3091. Physicians are encouraged to carefully review all proposed amendments to health plan or medical group/IPA contracts. Physicians who do not agree with the proposed change have the option to terminate the contract by providing 60 days written notice to Blue Shield. The termination notice must be received by Blue Shield within 45 days of receipt of the notice. It should be noted that if a physician terminates the contract according to these terms, the change will not apply to that physician during the termination notice period. SFMS/CMA has developed an action guide for physicians on contract amendments to help our members understand their rights when a health plan has sent notice of a material change to a contract. SFMS members can access this tool by logging into the SFMS website and click on the “For Physicians” --> Practice Management (http://www.sfms.org/ForPhysicians/PracticeManagement.aspx). The guide includes a discussion of options available to physicians when presented with a material change to a contract. The guide also includes a financial impact worksheet that can be used to calculate the net impact of the fee schedule changes to a practice. Comments are closed.
