The Record - for physicians and other health care providers to share with their office staffs Forward to a friend  |  Subscribe  |  The Record Archive  |  Contacts  |  bcbsm.com  |  Print this article
April 2015

Blue Cross Blue Shield of Michigan to change professional provider fees July 1

Blue Cross Blue Shield of Michigan will change practitioner fees, effective with dates of service on or after July 1, 2015, for services provided to our Traditional, TRUST, Blue Preferred PlusSM and Blue Cross® Metro Detroit EPO members, regardless of customer group.

Blue Cross will use the 2015 Medicare resource-based relative value scale for all relative value unit-priced procedures for dates of service on and after July 1. Most fees are currently priced using the 2014 values.

Changes in resource-based relative values can impact fees. Procedure code maximum fees will increase or decrease based on the new relative value units and Blue Cross’ conversion factors.

At the same time, the regional conversion factors for non-relative value, unit-based anesthesia services will remain unchanged, pending expected modifications later in 2015.

We conduct a comprehensive analysis of professional provider performance and current economic indicators annually to calculate practitioner fees, with consideration for corporate and customer cost concerns. Blue Cross remains committed to reviewing professional provider performance to determine the need for increases or decreases in our maximum payments.

Fee schedules with the new fees that are effective July 1, 2015, will be available on web-DENIS April 1. Click on Entire Fee Schedules and Fee Changes on the web-DENIS BCBSM Provider Publications and Resources page to find fee information. Only claims submitted with dates of service on or after July 1 will be reimbursed at the new rates.

Please note that the Physician Group Incentive Program physician organization reward component of professional fees remains the same this year.

For more information, contact your Blue Cross provider consultant.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.