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Payment Reductions Applied to Professional Components on Radiology Claims to Be Corrected

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) recently learned that changes made to our claims processing systems have resulted in our accidently applying multiple procedure payment reductions (MPPR) on the professional components of claims reporting overlapping diagnostic imaging services.  We are in the process of correcting this error and impacted radiology claims will be identified through internal reports. Radiology claims reporting professional components and mistakenly applied reductions will be adjusted for all eligible, additional payments.   

Radiology providers are aware that Blue Cross NC revised its Radiology Services Reimbursement Policy in August of this year. The revised policy was written specific to the technical components of radiology services and did not include professional components. Our intent was to apply MPPR to the technical components of claims, while we internally evaluated applying MPPR to professional components in the future, as MPPR on professional components has been an industry recognized practice since 2012.  However, due to an internal miscommunication we unintentionally included the professional components along with the technical components in our system’s configurations for claims editing. Blue Cross NC is stopping these reductions on radiology professional claims and will be making payment adjustments for inaccurately processed claims, for dates of service on and after August 1, 2017.   

However, Blue Cross NC will be adding the professional components of secondary diagnostic imaging services to its Radiology Services Reimbursement Policy for 2018, and making MPPR applicable to professional components in addition to the technical components. Blue Cross NC must ensure our reimbursement policies are aligned appropriately with industry standards and support our ability to continue offering our customers competitive options for affordable health care coverage. Therefore, we will be aligning Blue Cross NC with the Centers for Medicare and Medicaid Services (CMS), and other industry payers in the management of overlapping diagnostic imaging services. For additional information about this policy change, please read this information about the Radiology Services Reimbursement Policy Being Updated to Include Professional Components.