Blue Cross reinstates reimbursements for medical record requests related to diagnoses submission

We recently told you about a policy change, effective May 1, 2015, related to reimbursement for Blue Cross Blue Shield of Michigan risk adjustment medical records. This change indicated we would no longer reimburse in-network physicians for the administrative costs associated with medical record retrieval.

We’ve decided to suspend that policy retroactive to May 1, 2015. The previous risk adjustment policy, which reimbursed in-network, Medicare Advantage physicians for medical records, will remain in effect. You may resume submitting reimbursement requests under that policy. We apologize for any inconvenience this shift may have caused.

As you know, the Centers for Medicare & Medicaid Services expects health plans and providers to conduct accurate documentation and complete medical record coding. Performing well in this regard is in our collective best interest. We appreciate your continued partnership in meeting these compliance expectations.

As we look to the future, we believe electronic medical record connectivity between Blue Cross, Blue Care Network and the provider community will reduce costs and administrative challenges.

We’ll continue striving to use information technology, wherever possible, to reduce the need for providers and Blue Cross to manually collect medical records. To that end, we’re working to identify additional connectivity options to support our provider community in the use of electronic medical records and retrieval.

Contact your provider consultant if you have any questions or concerns related to medical record requests.