Blue Cross and Blue Shield of North Carolina is digging in its heels when it comes to reimbursing providers for a specific radiology procedure, which it called "wasteful spending," according to a News & Observer report.
The "technical component" of MRIs includes the routine aspects of the procedure, including setting the patient up in the exam room and when the technician takes several images of the patient's organs. The cost for each separate MRI image is roughly $1,746, according to the report, and $1,511 goes toward the technical component.
BCBS of North Carolina says providers are charging identical prices for each image taken during patients' radiology session. They are billing for the technical component for second and subsequent images taken, despite only having to set the patient up once.
"It's unfair for our members to pay more than once for items only supplied one time," Barbara Morales Burke, vice president of health policy for Blue Cross, said in the report. "We are reducing wasteful spending."
The payor released a memo last year, noting that "allowance" for the technical component of second and subsequent images would be changed from 100 percent to 50 percent. Providers accused the payor of changing reimbursement terms that were set in contracts. They claimed the change violated a 2009 law, under which insurers' contract amendments cannot go into effect if a provider objects to them.
BCBS of North Carolina maintains the change was not in violation of their contract. "This is a change to our reimbursement policy, not the fee schedule," Ms. Burke said in the report.
The state Department of Insurance has sided with providers, but BCBS of North Carolina has appealed its decision.
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The "technical component" of MRIs includes the routine aspects of the procedure, including setting the patient up in the exam room and when the technician takes several images of the patient's organs. The cost for each separate MRI image is roughly $1,746, according to the report, and $1,511 goes toward the technical component.
BCBS of North Carolina says providers are charging identical prices for each image taken during patients' radiology session. They are billing for the technical component for second and subsequent images taken, despite only having to set the patient up once.
"It's unfair for our members to pay more than once for items only supplied one time," Barbara Morales Burke, vice president of health policy for Blue Cross, said in the report. "We are reducing wasteful spending."
The payor released a memo last year, noting that "allowance" for the technical component of second and subsequent images would be changed from 100 percent to 50 percent. Providers accused the payor of changing reimbursement terms that were set in contracts. They claimed the change violated a 2009 law, under which insurers' contract amendments cannot go into effect if a provider objects to them.
BCBS of North Carolina maintains the change was not in violation of their contract. "This is a change to our reimbursement policy, not the fee schedule," Ms. Burke said in the report.
The state Department of Insurance has sided with providers, but BCBS of North Carolina has appealed its decision.
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