Practice Management

Hi,

We have noticed Highmark BCBS's reimbursement for the new Mammography codes (77067, 77066 & 77065) are 40% below Medicare 2018 rates and 33% below Highmark's 2017 rates for the old codes.  Has anyone else seen such a drastic reduction from Highmark BCBS or any other commercial payer?

Thanks!

 

------------------------------
Vicki Parikh
Practice Administrator
Mid-Delaware Imaging
302.734.9888
www.mdidover.com
------------------------------

Yes we saw a 40% reduction on the technical component for these codes from BCBS of Mass.   The ACR and the Mass Radiological Society are trying to work with BCBS, but have not been successful.

------------------------------
Christie James MS, FRBMA
Radiology Revenue Cycle Management
Massachusetts General Physicians Org.
Charlestown MA
(617) 724-4106
------------------------------

Original Message:
Sent: 01-23-2018 11:14
From: Vicki Parikh
Subject: New Mammo Code Reimbursement

Hi,

We have noticed Highmark BCBS's reimbursement for the new Mammography codes (77067, 77066 & 77065) are 40% below Medicare 2018 rates and 33% below Highmark's 2017 rates for the old codes.  Has anyone else seen such a drastic reduction from Highmark BCBS or any other commercial payer?

Thanks!

 

------------------------------
Vicki Parikh
Practice Administrator
Mid-Delaware Imaging
302.734.9888
www.mdidover.com
------------------------------

While re-assuring to hear we are not the only ones, this is a drastic reduction. We used to have a Provider Rep, but they did away with that, so now we have no direct contact at Highmark BCBS.  Is there anything we can do??  If anyone has recommendations of how we can protest this, please let me know.  



------------------------------
Vicki Parikh
Practice Administrator
Mid-Delaware Imaging
Dover DE
3027349888 x128
------------------------------

Original Message:
Sent: 01-24-2018 09:14
From: Christie James
Subject: New Mammo Code Reimbursement

Yes we saw a 40% reduction on the technical component for these codes from BCBS of Mass.   The ACR and the Mass Radiological Society are trying to work with BCBS, but have not been successful.

------------------------------
Christie James MS, FRBMA
Radiology Revenue Cycle Management
Massachusetts General Physicians Org.
Charlestown MA
(617) 724-4106

Original Message:
Sent: 01-23-2018 11:14
From: Vicki Parikh
Subject: New Mammo Code Reimbursement

Hi,

We have noticed Highmark BCBS's reimbursement for the new Mammography codes (77067, 77066 & 77065) are 40% below Medicare 2018 rates and 33% below Highmark's 2017 rates for the old codes.  Has anyone else seen such a drastic reduction from Highmark BCBS or any other commercial payer?

Thanks!

 

------------------------------
Vicki Parikh
Practice Administrator
Mid-Delaware Imaging
302.734.9888
www.mdidover.com
------------------------------

We are addressing the reduction through the Mass Radiological Society, but it doesn't seem to be moving the needle.   We also found out that one of our local payers has applied the MPPR on screening tomo.   They are reducing the 26 and the global 50% when billed with a mammogram.   Has anyone else experienced this?

------------------------------
Christie James MS, FRBMA
Senior Manager, Radiology Revenue Cycle
Massachusetts General Physicians Org.
Charlestown MA
(617) 724-4106
------------------------------

Original Message:
Sent: 01-25-2018 14:41
From: Vicki Parikh
Subject: New Mammo Code Reimbursement

While re-assuring to hear we are not the only ones, this is a drastic reduction. We used to have a Provider Rep, but they did away with that, so now we have no direct contact at Highmark BCBS.  Is there anything we can do??  If anyone has recommendations of how we can protest this, please let me know.



------------------------------
Vicki Parikh
Practice Administrator
Mid-Delaware Imaging
Dover DE
3027349888 x128

Original Message:
Sent: 01-24-2018 09:14
From: Christie James
Subject: New Mammo Code Reimbursement

Yes we saw a 40% reduction on the technical component for these codes from BCBS of Mass.   The ACR and the Mass Radiological Society are trying to work with BCBS, but have not been successful.

------------------------------
Christie James MS, FRBMA
Radiology Revenue Cycle Management
Massachusetts General Physicians Org.
Charlestown MA
(617) 724-4106

Original Message:
Sent: 01-23-2018 11:14
From: Vicki Parikh
Subject: New Mammo Code Reimbursement

Hi,

We have noticed Highmark BCBS's reimbursement for the new Mammography codes (77067, 77066 & 77065) are 40% below Medicare 2018 rates and 33% below Highmark's 2017 rates for the old codes.  Has anyone else seen such a drastic reduction from Highmark BCBS or any other commercial payer?

Thanks!

 

------------------------------
Vicki Parikh
Practice Administrator
Mid-Delaware Imaging
302.734.9888
www.mdidover.com
------------------------------

Original Message------

We are addressing the reduction through the Mass Radiological Society, but it doesn't seem to be moving the needle.   We also found out that one of our local payers has applied the MPPR on screening tomo.   They are reducing the 26 and the global 50% when billed with a mammogram.   Has anyone else experienced this?

------------------------------
Christie James MS, FRBMA
Senior Manager, Radiology Revenue Cycle
Massachusetts General Physicians Org.
Charlestown MA
(617) 724-4106
------------------------------

I was referring to 2018 Dates of Service. 

We have not specifically encountered the issue with the MPPR reduction on Mammo/Tomo, but will certainly keep an eye out for it!

We did experience incorrectly applied MPPR reduction from Highmark BCBS for over a year, but through MUCH persistence we were able to get that corrected.  It was similar to what you are describing though.

------------------------------
Vicki Parikh
Practice Administrator
Mid-Delaware Imaging
Dover DE
3027349888 x128
------------------------------

Original Message:
Sent: 01-26-2018 19:01
From: Teresa Chao
Subject: New Mammo Code Reimbursement

Is this for 2017 or 2018 dates of service? 

 

Original Message------

We are addressing the reduction through the Mass Radiological Society, but it doesn't seem to be moving the needle.   We also found out that one of our local payers has applied the MPPR on screening tomo.   They are reducing the 26 and the global 50% when billed with a mammogram.   Has anyone else experienced this?

------------------------------
Christie James MS, FRBMA
Senior Manager, Radiology Revenue Cycle
Massachusetts General Physicians Org.
Charlestown MA
(617) 724-4106
------------------------------

Update: I went through the Medical Society of Delaware who was able to put me in touch with someone at Highmark who resolved this issue.  It seems they were not aware the Mammography codes had changed in 2018 and thus did not realize the pricing was altered. They have corrected the fee schedule to reflect 2017 pricing. Next step is to resubmit all the claims that have been submitted thus far!

------------------------------
Vicki Parikh
Practice Administrator
Mid-Delaware Imaging
Dover DE
3027349888 x128
------------------------------

Original Message:
Sent: 01-30-2018 10:17
From: Vicki Parikh
Subject: New Mammo Code Reimbursement

I was referring to 2018 Dates of Service.

We have not specifically encountered the issue with the MPPR reduction on Mammo/Tomo, but will certainly keep an eye out for it!

We did experience incorrectly applied MPPR reduction from Highmark BCBS for over a year, but through MUCH persistence we were able to get that corrected.  It was similar to what you are describing though.

------------------------------
Vicki Parikh
Practice Administrator
Mid-Delaware Imaging
Dover DE
3027349888 x128

Original Message:
Sent: 01-26-2018 19:01
From: Teresa Chao
Subject: New Mammo Code Reimbursement

Is this for 2017 or 2018 dates of service? 

 

Original Message------

We are addressing the reduction through the Mass Radiological Society, but it doesn't seem to be moving the needle.   We also found out that one of our local payers has applied the MPPR on screening tomo.   They are reducing the 26 and the global 50% when billed with a mammogram.   Has anyone else experienced this?

------------------------------
Christie James MS, FRBMA
Senior Manager, Radiology Revenue Cycle
Massachusetts General Physicians Org.
Charlestown MA
(617) 724-4106
------------------------------