Tag: Blue Cross Blue Shield

NEW YORK – AMC Health will provide certain Medicare Advantage enrollees who have congestive heart failure and chronic obstructive pulmonary disease with Bluetooth monitoring devices to transmit real-time biometric data to its clinicians as part of a new partnership with Blue Cross & Blue Shield of Rhode Island.  Launching this program helps to better ensure that pre-acute exacerbations of...

WATERLOO, Iowa - The VGM Group has helped providers in Maryland, Washington, D.C., and Virginia beat back CareFirst BlueCross BlueShield's plans to reduce the number of providers in its network that are authorized to provide CPAP equipment. The insurer planned to limit its network to a few providers after Feb. 15, 2019. When VGM heard from members about CareFirst's decision, it filed a complaint with the Maryland Insurance Administration and after some back and forth CareFirst agreed to allow...

RALEIGH, N.C. - Blue Cross Blue Shield Of North Carolina announced Dec. 13 that it will not update current fee schedules with the 2017 rates recently released by CMS. Because the decision is in conflict with its current policy and current contracts with DME providers, a contractual amendment will be mailed in early to mid-January, with an effective date of Jan. 1, 2017. It will continue to use the January 2016 rates until further notice. "Our association has worked hard over the years maintaining...

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...

MINNEAPOLIS - Blue Cross Blue Shield of Minnesota and the Allina Integrated Medical Network of Allina Health have partnered on a new health plan focused on greater patient engagement, collaborative clinical care management between the plan and providers, and guided patient care services. Care options for the plan, called BluePrint, will encompass the extensive services available through the Allina Integrated Medical Network, including specialty care practices providing oxygen and home medical equipment....

YARMOUTH, Maine - Some Medicare Advantage (MA) plans are starting to look more and more like traditional Medicare, industry sources say. In the wake of CMS's announcement of the Round 2 payment amounts, a Blue Cross Blue Shield MA plan in one state, for example, has shaved 10% off its reimbursement for HME. Another plan going in that direction: Windsor, says Tyler Poole. “We anticipated this,” said Poole, vice president of operations for Benefits365, a company that helps providers...

A policy change by one of the nation's largest insurers has some HME providers feeling the blues, say industry stakeholders.In October, Blue Cross Blue Shield (BCBS) began requiring providers to bill the insurance plan for the state in which the subscriber—the patient—is located.“Historically, providers have always billed their home state for every patient they service, but now they are not allowed to do that,” said Sylvia Toscano, owner of Professional Medical Administrators....

MONTGOMERY, Ala. - HME providers in Alabama are taking in stride recent changes to Medicaid and Blue Cross Blue Shield. In October, the state's Medicaid program became the second in the country to require that certain HME providers obtain surety bonds, according to Michael Hamilton, executive director of the Alabama Durable Medical Equipment Association (ADMEA). The first: Florida. "We negotiated exemptions for most of our members, so we did good," he said. Exemptions include HME providers who...

NASHVILLE, Tenn. - Tennessee is the latest state where BlueCross BlueShield (BCBS) is wreaking havoc on HME providers. To cut costs, Volunteer State Health Plan, a subsidiary of BlueCross BlueShield of Tennessee and one of three managed care organizations to administer benefits for TennCare, the state's Medicaid program, recently signed a contract with CareCentrix to handle DME claims. In turn, CareCentrix wants to pay DME providers, on average, 15% less than they're currently getting paid, according...

BOSTON - Providers here who count Blue Cross Blue Shield (BCBS) of Massachusetts among their payers may find themselves shut out if the insurer decides to limit its provider network. On July 1, BCBS sent out a confidential request for information (RFI) to providers. The 16-page document states: The information you provide may also be used to develop a limited or select network of affordable high quality DME providers focused on clinical outcomes, efficiencies and cost effective care. "We did...