Blue Cross discontinues reimbursements for medical records requests related to diagnoses submission

Beginning May 1, 2015, Blue Cross Blue Shield of Michigan will no longer reimburse all-network physicians, hospitals or facilities for administrative costs related to medical records retrieval for risk adjustment purposes. This aligns Blue Cross practices with those of Blue Care Network, which does not reimburse for chart requests.

Annually, Blue Cross and BCN requests medical records from our health care providers to meet Centers for Medicare & Medicaid Services’ standards for data submission and diagnosis coding accuracy. These reviews are conducted to evaluate the accuracy of patient diagnoses submitted for payment to CMS.We’ve found that only a small percentage of providers request reimbursement for the administrative costs involved in the copying and faxing or mailing of risk adjustment-related records to Blue Cross. Blue Cross will continue to reimburse for medical records requests related to HEDIS.

Keep in mind that some of our vendor partners offer a secure portal or electronic file transfer that allows you to upload or send medical records electronically, thereby eliminating the cost of copying and mailing records.

Please contact your provider consultant if you have any questions or concerns related to medical record requests. You may also refer to the Medical Records Requests Frequently Asked Questions document for more information.