BCBS Settlement Finalized, Checks Mailed

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  • September 2, 2009
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The final appeal in the Love v. Blue Cross Blue Shield (BCBS) settlement was dismissed on June 19, finalizing the settlement. BCBS began sending checks July 22 to physicians who filed valid claims, reports Coding News.

The BCBS settlement resulted in a payout to physicians of roughly $131 million. 

If your practice properly filed a claim, but you haven’t received a settlement check yet or did not receive the amount your practice expected, contact the claims administrator at jpenning@epiqsystems.com.

The provisions in the settlement agreement requiring the settling BCBS companies to follow most CPT® rules are effective Jan. 21. As seen on HMOsettlements.com, these provisions require:

  • Payment of add-on codes without reduction for Multiple Procedure Logic;
  • Separate recognition and payment of evaluation and managment (E/M) codes appended with modifier 25 Reduced Services when billed with a service procedure or surgical code;
  • Separate recognition and payment for supervision and interpretation and radiologic guidance codes;
  • Payment for codes submitted with modifier 59 Distinct Procedural Service to the extent they follow CPT® rules regarding designation of separate procedures;
  • Prohibition on global periods for surgical procedures longer than CMS’; and
  • Prohibition on automatic reduction of CPT® codes to codes of lesser intensity.

For a summary of the key business practices mandated in the BCBS settlement, read the American Medical Association’s (AMA) “How the Blue Cross Blue Shield Settlement Agreement Helps the Physician Practice” on their Web site.

The AMA is encouraging physicians to review their contracts to ensure they are receiving available protections.


No Responses to “BCBS Settlement Finalized, Checks Mailed”

  1. Darcie K. says:

    Does anyone know what the “CM’s” are in the 5th bullet point of the provisions? I know I am going to have an “ah-ha” moment when I hear it 🙂 Thanks!

  2. Ashley C says:

    Hi Darcie,
    CMS is Centers for Medicare and Medicaid Services 🙂