July Fee Schedules and Reimbursement Notices

Blue Cross Blue Shield of North Dakota (BCBSND) posted 2022 fee schedules and reimbursement notices to the Online Fee Schedule Portal June 1, 2022 for professional and May 1, 2022 for institutional. This was communicated in Healthcare News on May 1, 2022. The fee schedules will be effective July 1, 2022, through June 30, 2023, unless you have a specific contract arrangement for a different timeline.

Several changes to reimbursement methodologies for institutional services were made as part of the July 2022 update to more accurately reflect reimbursement based on cost.  Please review reimbursement notices and email communications to see impacts to your facility.  Some of the changes are outlined below.

Enhanced Ambulatory Patient Groups (EAPG) system:

All Behavioral Health, End State Renal Disease (Dialysis Centers), Outpatient Rehab and Ambulatory Surgery Centers will be moved to the EAPG Outpatient Reimbursement methodology effective July 1, 2022.  Most of the providers in these categories are currently on the EAPG payment system and BCBSND plans to continue to transition away from the previous outpatient reimbursement system.

Critical Access Hospitals:

Critical access hospitals will be moved from the APR DRG system to per diem rates for inpatient services and percentage of charge for outpatient services to align with methodologies used by CMS, as well as other BCBSND-related products, such as Medicaid Expansion and NextBlue Medicare Advantage. Individual rates were communicated via email from Contracting and Network Management.

Medical Education Cost Reimbursement:

Facilities that qualify for the medical education cost add-on payment, this has now been added to the APR DRG base rate instead of a separate payment. 

Please visit the Online Fee Schedule Portal to review fee schedules and reimbursement notices. When logging into the Online Fee Schedule Portal, please note you will need to change your password as updates have been made to the portal. 

If you have questions regarding the 2022 fee schedules, please email FeeSchedules@bcbsnd.com