Blue Cross Blue Shield Settlement

The final appeal in the Blue Cross Blue Shield Settlement was dismissed on June 12, 2009 and as such, the settlement has been finalized. The settlement administrator mailed the settlement checks to class members on July 22, 2009.

* CODING PROVISIONS IN BLUE CROSS BLUE SHIELD ASSOCIATION SETTLEMENT TAKE EFFECT JANUARY 21, 2009

The provisions in the Settlement Agreement reached between physicians and the Blue Cross Blue Shield Association requiring the settling Blues companies to follow most CPT® rules take effect on January 21, 2009. These provisions require:

• Payment of add-on codes without reduction for Multiple Procedure Logic
• Separate recognition and payment of E&M codes appended with a 25 modifier when billed with a service procedure or surgical code
• Separate recognition and payment for supervision and interpretation and radiologic guidance codes
• Payment for codes submitted with 59 modifiers to the extent they follow CPT rules regarding designation of separate procedures
• Prohibition on global periods for surgical procedures longer than CMS’
• Prohibition on automatic reduction of CPT codes to codes of lesser intensity

In addition, most of the other provisions in the Blue Cross Blue Shield Association Settlement Agreement have already taken effect. These include, but are not limited to, a prohibition on collecting an alleged overpayment beyond 18 months (or less if a lesser period is specified by state law), 90 days’ advance notice of material adverse changes, and application of a clinical based definition of medical necessity.

Any physician who believes that a settling Blues company has violated one of these provisions can file a compliance dispute with the Class Compliance Dispute Facilitator, Deborah J. Winegard. She can be reached at (404) 607-8222 or at dwinegard@gmail.com.