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May 2017

Cost of external peer reviews to increase

The cost of external peer reviews for facilities (including hospitals) and doctor’s offices is increasing, effective Aug. 1, 2017. Peer reviews are typically requested by health care providers when they dispute an audit finding.

Here’s a look at the current and new fees:

Facility standard clinical review
Current: $350 per review
New (effective Aug. 1): $360 per review

Facility coding review
Current: $312 per review
New (effective Aug. 1): $318 per review

Professional standard clinical review
Current: $125 per hour
New (effective Aug. 1): $145 per hour

Professional standard coding review
Current: $100 per hour
New (effective Aug. 1): $115 per hour

According to Blue Cross Blue Shield of Michigan participation agreements with health care providers, if the peer review agency upholds Blue Cross’ decision regarding a claim, the facility or practitioner’s office will pay the cost of the appeal review.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2016 American Medical Association. All rights reserved.
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