Private pay rates below bid rates

Friday, October 25, 2013

BlueCross BlueShield in several states plans to implement new payment rates this fall that look a lot like the Round 2 bid rates, and in some cases, worse.

“They cut rates about 40%,” said Todd Tyson, founder of Hi-Tech Healthcare in Norcross, Ga., where the new fee schedule goes into effect Nov. 1. “In some cases, the rates are 6% to 8% below the Round 2 bid rates.”

The single payment amounts for Round 2, implemented July 1, are, on average, 45% lower than the Medicare fee schedule.

It’s the same story in Indiana: Rates match or are below the bid rates, says George Kucka. He says officials have told him the rates, slated to take effect Nov. 1, are proprietary market rates, not an attempt to follow the bid rates. 

Kucka has drafted a letter to officials at BCBS of Indiana explaining why the new rates are unsustainable and asking for a conference call.

“My goal is to at least get them to implement a moratorium to give them more time to analyze the ramifications of these rates,” said Kucka, president of Fair Meadows Home Health Center in Schererville, Ind. “We are already getting access issues here because of competitive bidding. There aren’t enough providers left. Is it cheaper for (BCBS) to have people stay in the hospital longer?”

In Georgia, at least, BCBS officials believe they have plenty of providers, say stakeholders.

“They have indicated that their network is closed and said that every day they are bombarded with DME providers wanting to join,” said  Teresa Tatum, executive director of the Georgia Association of Medical Equipment Services. “We said, maybe they haven’t seen the new fee schedule.”

Tatum and two providers held a conference call with BCBS officials in September, in which they offered to work with the payer to find savings in other areas. They also asked the insurer to consider a delay to give providers time to make changes to their operations that would allow them to service patients, she said.

“They declined because they had given us the 60 days,” said Tatum. “They are willing to listen to individual providers for specific situations (as problems arise).”