NC Blues wins fight over duplicate radiology fees

The state decision could save Blue Cross Blue Shield of North Carolina $16 million a year
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Blue Cross Blue Shield of North Carolina has won its fight against providers who charge the insurer identical radiology fees. The state insurance department decided BCBSNC doesn't have to pay the same fee for multiple medical scans, a decision that could save the insurer $16 million a year.

BCBSNC said the duplicate billing occurs when medical technicians take multiple images during a radiology test, including MRIs and ultrasounds, and then charge the insurer the same "technical component" fees, including setting up IV fluids, regardless if the image setup is only performed once, reported the Charlotte Observer.

What's more, the North Carolina Department of Insurance said BCBSNC can update its existing reimbursement policies accordingly--without renegotiating with providers, WRAL reported.

The issue began last year when BCBSNC told providers it would reduce the technical fee for subsequent images by 50 percent. Hospitals and doctors pushed back against the insurer's decision, claiming it was changing the contract reimbursement terms, which requires negotiations.

In response to the state's decision, Medical Society CEO Robert Seligson said they will likely appeal. "We will continue to stand strongly for the basic principle that when an insurer signs a contract, whether it's with a doctor or a patient, the expectation is that they will do what has been promised," he said in an emailed statement to the Triangle Business Journal. "We promise you that this fight is not over," he added.

To learn more:
- read the Charlotte Observer article
- see the WRAL article
- check out the Triangle Business Journal article

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