BCBSND is delaying the implementation of the Enhanced Ambulatory Patient Groups (EAPG) outpatient reimbursement methodology and the update to the APR-DRG inpatient reimbursement methodology.
The new EAPG implementation and APR-DRG update is set to take effect on October 1, 2020.
1. Will BCBSND make any adjustments to the institutional fee schedule in order to adjust the fees paid to providers during the interim? (Interim = July 1, 2020 to September 30, 2020)
BCBSND is committed to this delay not having a negative impact to provider reimbursement. BCBSND is working through options with the goal of having additional information available to providers prior to or during the week of April 27, 2020.
2. Will the delay in the implementation and update noted above also apply to the institutional services that are paid on a Per Diem basis?
A final decision has not been made on what impact the delay noted above may have on our ability to implement the update to the Per Diem rates. Decisions regarding a change to the Per Diem rate schedule will depend upon the method used to deliver the payment adjustments to providers during the interim period.
3. Is BCBSND re-scheduling the provider EAPG sessions that were cancelled?
Yes, the EAPG sessions will be rescheduled. The date and format that will be used to deliver this information will be contingent upon how long the COVID-19 outbreak continues.
4. If I have any questions about the institutional fee schedule prior to when I receive the Reimbursement Notice, who can I reach out to?
If providers have any questions between now and when the Reimbursement Notice is sent out, they can email them to firstname.lastname@example.org.