NC Blues fights paying identical radiology fees

Blue Cross Blue Shield of North Carolina (BCBSNC) is pushing back against a common practice among providers to charge identical fees for each image taken during radiology tests, such as MRIs and ultrasounds, regardless if the image setup is only performed once.

"We believe billing multiple times for services and items received only once is unreasonable and unfair to our customers," BCBSNC spokesman Lew Borman told FierceHealthPayer.

Essentially, North Carolina's largest insurer claims that providers are charging the full rate for each image taken even though each subsequent image costs less to perform. This practice of billing the "technical component" of an imaging test--including when technicians greet patients, set up fluids, prepare exam rooms and take images--amounts to $16 million a year in overcharges, the Charlotte News & Observer reported.

What's more, BCBSNC alleges that some hospitals have been making record profits as they raise prices for common imaging tests. "It's unfair for our members to pay more than once for items only supplied one time," BCBSNC Vice President of Health Policy Barbara Morales Burke told the News & Observer. "We are reducing wasteful spending."

BCBSNC last year mailed a memo to providers that perform radiology services, explaining that it would pay 50 percent of the technical component fee for subsequent images, although it would continue to pay doctors 100 percent for each image they analyze and interpret.

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"We believe billing multiple times for services and items received only once is unreasonable and unfair to our customers."

--Lew Borman, BCBSNC spokesman
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"We've offered a reasonable and fair solution to end this wasteful spending and save consumers' money," Borman said. He added that this payment adjustment is similar to the Medicare fee schedule for imaging.

Providers, including the North Carolina Hospital Association (NCHA), claimed the insurer was breaching contracts by amending fee schedules. "If an insurer can change the reimbursement terms of a provider contract whenever it wants, what is the point of having a contract?" the NCHA said. "There is no end to an insurer's ability to unravel the reimbursement terms that it has agreed to if it can adopt 'policies' whenever it wants to change those terms."

BCBSNC, however, said the change is to its reimbursement policy, not the fee schedule. "We absolutely disagree with that view that it is in violation of our contracts," Burke said in the article.

NCHA also argued that BCBSNC's reimbursement change violated state law that prevents a contract amendment from going into effect if a provider objects. The state department of insurance sided with the providers, and Blue Cross has since appealed the decision, requesting a public hearing on the issue, Borman said.

To learn more:
- read the Charlotte News & Observer article

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