With only a few days remaining until changes take effect for Blue Cross of Michigan capped rentals, If you are a Blue Cross of Michigan Provider please review the information below and take action.
Prepare for Blue Cross of Michigan Capped Rental Rules Change!
Unfamiliar with what's going on? Get the foundation here, then work toward step 3 :)
Step 1: get your test environment updated with a fresh copy of your data
Step 2: working in test, run an active rental report for your Blue Cross of Michigan Capped rentals, so that you have this to reference as a working report before tables changes are made.
Step 3: Understand the Basics of the issue:
BCBSM indicated on their January call that on March 1st, 2018 any active capped rentals will continue to rent and be paid until they’ve reached 13 rental months. BCBSM was asked at what rate will they pay the extended capped rentals that began under the 10-month rule, now that they have established a new fee schedule for the 13-month capped rentals. They seem unsure and said there would be no decreases during these months, but they are subject to audit. BCBSM indicated that they would extend the Length of Need on prescriptions to 13 so that Providers did not have to recert existing 12-month prescriptions for these capped rentals. BCBSM indicated that they would not be using Medicare Capped Rental modifiers.
Step 4: Review Payer Type Settings
Rental Settings in the Payer Types table are the primary rule governors for rentals. In the next step we will hunt for EXCEPTIONS to your Payer Type rules, which would be found in the Bill Code table. Question 1: Is your Blue Cross of Michigan payer tied to a payer type that has many other payers in it? Not Sure? Nav to this report and run it for the Payer Type in question: Reports>Table Reports> Payer Yes: Please consider creating a new Payer Type for your BCBSM payer, so that you don’t change the capped rental rules of all payers attached. No: Good, go on to Question 2. Question 2: What are your rental settings for this Payer Type?
Step 5: Review Bill Code Settings
The Bill Code table is where you've indicated something is considered a capped rental. Below that check box is an opportunity to enter capped rental months per procedure group & bill code that would overrule the Payer Type Table rental rules. These are EXCEPTIONS to the Payer Types rental rules. Question 1: . Do you know all of your bill codes that are marked as capped rental, and if they have special capped rental rules? No? We’ve created a Custom Report that you can run by Payer or Payer type. You will need to input the exact name of your payer or payer type in order to run the report, so double check the way your payer is named before executing. If you'd like this report at no charge, please contact Universal Support @ (810) 653-5000 x 1 or email firstname.lastname@example.org
Step 6: Time to make some decisions!
Let’s keep the big picture goal in mind: get paid for 13 months of rental. Our worst case scenario fail safe would be to have rentals with no rules that continued to turn over revenue until BCBSM stopped paying, and had to be manually Converted to Sale. We need to prevent rentals from capping before we reach 13 payments. Realistically you may have a combination of bill codes that rely on the Payer Type Table rental rules, and some that rely on their own capped rental rules. Here are some cause & effect outcomes to help you change your tables effectively. TEST FIRST! RUN RENTAL REPORT BEFORE & AFTER IN TEST. SPOT CHECK SOME OF YOUR EXISTING RENTAL IN EXISTING ORDER TO LOOK AT MONTH COUNTERS. Make sure you have a nice copy of your existing BCBSM rentals before you start making table changes! Try it in test mode first! Do you have anything to share, or questions to raise? Please leave us a comment!