Here’s more of what you need to know about the respiratory therapy services billing policy

Blue Cross Blue Shield of Michigan has updated its provider manuals to include a new policy that facilities should use when billing respiratory therapy services. The new policy went into effect Jan. 1, 2021, and we wrote about it in a January 2021 Record article.

We subsequently received some questions from providers about this change. Following is a list of answers to some frequently asked questions, which we hope will make the transition as smooth as possible for health care providers.

Q: Does the new policy pertain to both inpatient and outpatient?
A: The new policy pertains to inpatient only.

Q: Does there need to be a change in coding?
A: No. There will be no changes to revenue codes or units. The only change being made will be in the amount being charged.

Q: Can you give an example of how providers should be billing now for claims with admission dates of Jan. 1, 2021, and later, versus how they billed previously?
A: Yes. Let’s say that on a single day of service, a patient is on the ventilator for five hours and then weaned to CPAP for the remaining 19 hours. Previously, services were billed at a daily rate, regardless of hours used. But with the new policy, providers should be adjusting the charges billed to reflect only the hours used (for example, dividing the daily charge by 24 hours to determine an hourly charge and multiplying by actual hours used).

Q: Can these claims be audited?
A: Yes. Every claim is subject to audit.

Q: Why is Blue Cross making these changes when other payers have not?
A: Blue Cross has the obligation to make sure we pay claims correctly. The new policy supports this effort. We understand this may not have been how things were handled in the past, but industry norms have been shifting. Payers and customers are highly concerned that overpayment of claims is being overlooked and not identified up front. Implementing new, innovative ways to address and prevent overpayments early on will reduce the necessity for a back‑end review and recovery effort for both facilities and Blue Cross.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.