July 2020 Fee Schedule Update COVID-19 Disease 2020

Blue Cross Blue Shield of North Dakota (BCBSND) has been monitoring the impact the COVID-19 outbreak is having on the provider community’s operations. While working with internal operations and the third-party vendors which assist us with the annual fee schedule update process, an informed decision on the timing of the 2020 fee schedule update was made. The decisions are outlined below.

Institutional

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 feeschedules@bcbsnd.com.

Professional

BCBSND will implement the updates to the professional fee schedule on July 1, 2020, as scheduled.

1. How can BCBSND implement the updates to the professional fee schedule on July 1, 2020 while delaying the implementation of the institutional fee schedule updates?
BCBSND is confident the updates to the professional fee schedule can be made as scheduled. There are no significant rate calculation methodology changes planned and we do not work with an outside thirdparty vendor to determine the Relative Value Unit (RVU) weights or conversion factor(s) that are used to establish the payment amount for each of the codes.

2. Will we receive information on the proposed updates to the professional fee schedule prior to June 1, 2020?
Information will be provided when it is determined that providers may need advanced notice of any proposed changes or if we determine we would like providers’ input on any proposed changes, prior to making them.

Other

There are several fee schedules that either cross over the institutional and professional fee schedules, or have rates calculated based on the rate established for the other fee schedule. Examples of these include the Ambulance, Clinical Lab, Injectables and Home Medical Equipment Fee Schedules.

1. Will these rates be updated on July 1, 2020 or will they be delayed to October 1, 2020?
The timing of the updates to the fee schedules in this category will be determined on a case by case basis. The plan is to provide additional information to the provider community at the same time we publish the option that will be used to provide interim funding to providers, which is scheduled for some time the week of April 27, 2020, if not before.

BCBSND is committed to transparency on issues surrounding the 2020 updates to the fee schedules while acknowledging the demands placed on our provider community today and for the foreseeable future. BCBSND will continue to keep you posted as the fee schedule update process moves forward and recommendations are vetted.