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QUESTION – What are BCBS of Michigan Reimbursement Policies on Mid-Level Providers ?
ANSWER – Below are links of the official Blue Cross Blue Shield of Michigan publication, The Record, pertaining to the new policy for billing services rendered by Nonphysician Practitioners (PAs/NPs and CNMs). Also included below are some descriptive scenarios published by Blue Cross on their official website, “Web Denis.”
There have been many questions from MAPA members regarding this new policy and we are striving to share this important information to you in a timely fashion.
Please share this information with your supervising physician(s) and billing personnel.
Remember, this policy says that your practice can receive 100% reimbursement for services you provide when that service is discussed with your supervising physician before or after the visit. Documentation of that discussion is made by the PA; physician cosignature is no longer needed. If you provide autonomous services that do not require discussion with your supervising physician your bill to Blue Cross will be “direct” and your practice will receive 85% reimbursement.
MAPA strongly believes that this policy is still too restrictive and goes beyond the provisions outlined in our excellent state law. We are working on an appeal process to again register our dissatisfaction with this Blue Cross policy.
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Blue Cross Clarifies New PA Billing Rules...more work still needed!
The Michigan Academy of Physician Assistants has been working inexhaustibly to oppose the recent reimbursement policy changes recently enacted by Blue Cross Blue Shield of Michigan. As of April 1, 2008 PAs are eligible for reimbursement for the services they provide to BCBSM beneficiaries. (All these policies effect Nurse Practitioners and Certified Nurse Midwives as well.)
January 2008 The Record
Physician assistant registration now under way; new billing guidelines take effect April 1
April 2008 The Record
Policy for billing services rendered by nonphysician practitioners effective April 1
Billing scenarios for Direct and Indirect billing
June 2008 The Record
Physician assistant, certified nurse practioner services no payable for some auto group members.