Public Health Information
March 23, 2009 BCBS Settlement UpdateMCAG/MedRecover, LLC.HMO Class Action Lawsuit Update
This is an update is to inform hospitals and physician practices that BCBS Settlement has not released the funds.
BCBS Settlement Update:
The BCBS Settlement involving 42 plans nationwide was announced last October 2007. All physician claims submitted and approved will be sharing in the $135 million payout. At this time, the shares have been counted, and the settlement administrator is waiting for word from the court to distribute the funds. However, there is currently one outstanding appeal with this settlement that must be resolved before any funds are released. We are unsure of how long it will take for the appeal to run its course. Based on our most current information, we believe that the BCBS payments will be made in the first half of 2009.
Prospective Changes
While the settlement payouts have been substantial, the prospective changes required by the Court will have a far greater impact on future revenues. We are aware of payors who have not been fully compliant with the changes in business practices as mandated by the Southern District Federal Court. This continues to be a big issue for physicians and hospitals alike.
A few examples are:
- Better Medical Necessity Definition
- No Automatic Downcoding/Strict Adherence to American Medical Association (AMA) Current Procedural Terminology (CPT®)*
- - Modifier 25 separately identified and paid.
- - Modifier 59 separately identified and paid.
- - Supervision and interpretation codes separately identified and paid.
- - Add-on codes eligible for separate treatment.
- Disclosure of Fee Schedules/Payment Rules
- Limits on Contract Changes
- Immediate Payment on Capitations-Upon Enrollment
- Elimination of All Products Clauses
- Preference of Laws - State/Case Law
- Extensive Billing and Compliance Dispute Resolution System
If you have any further questions about the Settlements please feel free to contact MCAG (800) 355-0466 ext 1.
<< Back to list page
