After further analysis, Blue Cross Blue Shield (BCBSND) will not implement the 150% cap at charge for Critical Access Hospital (CAHs) per-diems for July 1, 2023, for our Commercial line of business. This includes acute-care per-diems only and does not impact swing bed per-diem rates as those are already being capped at 100% of charge. Additional information will be posted in an addendum to the July 1, 2023, Institutional Reimbursement Notice and will be posted to the Online Fee Schedule portal within the next few weeks.
Specific contractual arrangements that you have with BCBSND may supersede this communication. BCBSND will complete a thorough analysis for the July 1, 2024, Commercial payment update to determine an appropriate cap for this per-diem.
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